Just as it is with cyclosporine, overexposure to tacrolimus increases the risk of HCC recurrence after LT. Careful management of calcineurin inhibitors is recommended in HCC patients.

The objective of this study was to predict postoperative liver failure and morbidity after hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis. The model for end-stage liver disease (MELD) score is currently accepted as a disease severity index of cirrhotic patients awaiting liver transplantation; however, its impact on prognosis after resection of HCC on cirrhosis has never been investigated. One hundred fifty-four cirrhotic patients resected in a tertiary care setting for HCC were retrospectively analyzed. For each patient, the MELD score was calculated and related to postoperative liver failure and complications (morbidity). Hospital stay and 1-year survival was also investigated. MELD accuracy in predicting postoperative liver failure and morbidity of cirrhotic patients was assessed using receiver operating characteristic (ROC) analysis. Eleven patients (7.1%) experienced postoperative liver failure leading to death or transplantation. ROC analysis identified cirrhotic patients with a MELD score equal to or above 11 at high risk for postoperative liver failure (area under the curve [AUC] ϭ 0.92, 95% confidence interval [CI] ϭ 0.87-0.96; sensitivity ϭ 82%; specificity ϭ 89%). Forty-six patients (29.9%) developed at least 1 postoperative complication: ROC analysis identified patients with a MELD score equal to or above 9 at major risk for postoperative complications (AUC ϭ 0.85, 95% CI ϭ 0.78-0.89; sensitivity ϭ 87%; specificity ϭ 63%). Cirrhotic patients with MELD score below 9 had no postoperative liver failure and low morbidity (8.1%). In conclusion, the MELD score can accurately predict postoperative liver failure and morbidity of cirrhotic patients referred for resection of HCC and should be used to select the best candidates for hepatectomy. Liver Transpl 12: 966-971, 2006.

H epatocellular carcinoma (HCC) is a frequent finding in patients with chronic liver disease listed for liver transplantation (LT). Tumor recurrence after transplantation involves an ominous prognosis and strict selection criteria of transplant candidates on the basis of tumor features developed to minimize its incidence, among which the most widely adopted are the so-called Milan criteria. 1 Although it is known that the pharmacologic immunosuppression required after transplantation can accelerate tumor growth, the possible influence of different immunosuppressive schedules on HCC recurrence after LT had been poorly investigated until recently. 2,3 In a previous report, we demonstrated a close relationship between the amount of cyclosporine (CsA), one of the most widely adopted immunosuppressant drugs, administered during the first postoperative year and tumor recurrence in patients who underwent LT for HCC. 4 The aim of the current study was (1) to further investigate the possible relationship between the type and the degree of immunosuppression as expressed by exposure to the main immunosuppressant drug and tumor recurrence in patients transplanted for HCC and (2) to identify possible strategies to avoid tumor recurrence.The influence of different schedules of immunosuppression and many clinical, pathologic, and histologic factors on HCC recurrence also were investigated with univariate and multivariate analysis.Abbreviations: HCC, hepatocellular carcinoma; LT, liver transplantation; CsA, cyclosporine; AUC, area under the curve; AFP, alpha-fetoprotein; ROC, receiver operating characteristic; pT, pathologic tumor staging; OR, odds ratio; 95% CI, 95% confidence interval.From the

Hypothesis:To minimize the incidence of ischemic arterial complications, risk factors should be clearly identified. Knowledge of the predisposing factors for such complications would make possible the institution of strict surveillance protocols that could ensure early detection of complications and so prevent the progression of ischemic damage to graft failure.Design: Retrospective univariate and multivariate analysis.Setting: University hospital.Patients: Six hundred fifty-three adults who underwent 747 orthotopic liver transplantations. Main Outcome Measures:We used univariate and multivariate analyses to retrospectively assess the role of possible risk factors for early and late HA thrombosis (HAT) and stenosis (HAS), including etiology of liver disease, donor and recipient sex and age (aged Յ60 vs Ͼ60 years), cause of donor death, preservation solution, cold ischemic time, previous orthotopic liver transplanta-