Hepatocellular carcinoma recurrence after liver transplantation: Risk factors, screening and clinical presentation

Filgueira, Norma Arteiro

doi:10.4254/wjh.v11.i3.261

Cited by 101 publications

(111 citation statements)

References 78 publications

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“…Although AFP levels, the number of tumor lesions, and their size are considered well-established risk factors for HCC recurrence after LT, we did not find significant associations between those variables and HCC recurrence in our study [ 35 ]. The most probable explanation for that lack of association is insufficient statistical power related to our limited sample size.…”

Section: Discussioncontrasting

confidence: 69%

Risk Factors for Hepatocellular Carcinoma Recurrence and Survival after Liver Transplantation in Patients with HCV-Related Cirrhosis

Vidal

Pereira

et al. 2020

BioMed Research International

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Purpose. We aimed to identify prognostic factors for survival and recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for patients with HCC and hepatitis C virus-related cirrhosis (HCV-cirrhosis). Methods. This retrospective cohort study followed all adult patients with HCV-cirrhosis who underwent LT because of HCC or had incidental HCC identified through pathologic examination of the explanted liver at a university hospital in Rio de Janeiro, Brazil, over 11 years (1998-2008). We used Cox regression models to assess the following risk factors regarding HCC recurrence or death after LT: age, Model for End-stage Liver Disease score, Child-Pugh classification, alpha-fetoprotein (AFP), whether patients had undergone locoregional treatment before transplantation, the number of packed red blood cell units (PRBCU) transfused during surgery, the number and size of HCC lesions in the explanted liver, and the presence of microvascular invasion and necrotic areas within HCC lesions. Results. Seventy-six patients were followed up for a median (interquartile range (IQR)) of 4.4 (0.7-6.6) years. Thirteen (17%) patients had HCC recurrence during the follow-up period, and 26 (34%) died. The median survival time was 6.6 years (95% CI: 2.4-12.0), and the 5-year survival was 52.5% (95% CI: 42.3-65.0%). The final regression model for overall survival included four variables: age (hazard ratio (HR): 1.02, 95% CI: 0.96-1.08, P = 0.603 ), transplantation waiting time (HR: 1.00, 95% CI: 1.00-1.00, P = 0.190 ), preoperative AFP serum levels (HR: 1.01, 95% CI: 1.00-1.02, P = 0.006 ), and whether >4 PRBCU were transfused during surgery (HR: 1.15, 95% CI: 1.05-1.25, P = 0.001 ). The final cause-specific Cox regression model for HCC recurrence included only microvascular invasion (HR: 14.86, 95% CI: 4.47-49.39, P < 0.001 ). Conclusion. In this study of LT for HCV-cirrhosis, preoperative AFP levels and the number of PRBCU transfused during surgery were associated with overall survival, whereas microvascular invasion with HCC recurrence.

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Section: Discussioncontrasting

confidence: 69%

Risk Factors for Hepatocellular Carcinoma Recurrence and Survival after Liver Transplantation in Patients with HCV-Related Cirrhosis

Vidal

Pereira

et al. 2020

BioMed Research International

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“…For HCC patients, increasing importance has been attached to liver transplantation (LT) thanks to the advances in surgical techniques and immunosuppression regimens, resulting in the mean 1-year and 5-year survival rates of 85-90% and 70-75%, respectively [13][14][15][16][17][18]. However, about 16% HCC patients develop recurrence after LT [19][20][21][22][23][24][25][26]; besides, ICIs can activate the alloreactive T cells and give rise to acute rejection and graft loss, but its safety and efficacy for HCC patients undergoing LT remain a source of controversy. This paper aimed to review the ICIs-related graft rejection following LT from various aspects.…”

Section: Introductionmentioning

confidence: 99%

Liver graft rejection following immune checkpoint inhibitors treatment: a review

Yang

Sang

2019

Med Oncol

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Immune checkpoint inhibitors (ICIs) have demonstrated remarkable efficacy in a variety of solid tumors; nonetheless, they have not been well investigated and are still recognized as a relative contraindication for patients with a liver transplantation (LT) history, since ICIs treatment might potentially lead to graft rejection. The program death-1 (PD-1) and the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) pathways are implicated in the tolerance of transplanted organ, as well as blockade of the pathways, which contribute to eliminating tumors and may inadvertently lead to peripheral transplant rejection. Currently, no guidelines are available regarding the treatment for ICIs patients with a prior LT history. Therefore, this study was carried out to review the recent studies, attempting to introduce the ICIs-related graft rejection after LT from various aspects. We believed that ICIs could be given for the well-informed patients receiving LT and developed recurrence in a controlled setting. Typically, these patients should be treated according to a clinical care path or a prospective clinical trial, so as obtain a persistent anti-tumor immune response in the meantime of avoiding graft rejection, adjust the immunosuppression, reduce the possibility of graft loss following rejection, and have the opportunity to develop biomarkers for tumor response and transplant rejection.

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“…However, a benefit in the first 3 to 5 years for recurrence free survival and OS was evident. Regarding adverse events, both groups reported similar frequencies [53,54] .…”

Section: Adjuvant Therapymentioning

confidence: 76%

“…Clinicians should be aware of the increased risk of post-transplant HCC recurrence with calcineurin inhibitors [54] . In a systematic review of 42 publications, patients on everolimus had significantly lower recurrence rates of HCC versus calcineurin inhibitors and sirolimus [52] .…”

Section: Adjuvant Therapymentioning

confidence: 99%

Living donor liver transplantation for patients with advanced hepatocellular carcinoma

Cullen¹,

Vargas²,

Goldaracena³

2020

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Liver transplantation (LT) is the treatment of choice for patients with hepatocellular carcinoma (HCC) and underlying liver disease. Given the organ scarcity, LT for patients with HCC have been restricted to those patients associated with the highest survivals. However, many patients with extended criteria HCC can still benefit from LT, but due to deceased organ shortage, they are not offered that opportunity. Living donor liver transplantation (LDLT) emerged as a successful strategy to overcome organ shortage around the world and as LDLT experience grows, this technique might offer the opportunity to expand the indications of LT to patients with advanced HCC. Therefore, since LDLT is not competing for deceased donor organs, many patients with extended criteria HCC who could still benefit from transplantation may have access to this treatment option. In this review, we will discuss the role of LDLT for patients with advanced-stage HCC and how LDLT allows for safe expansion of HCC transplant criteria.

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Hepatocellular carcinoma recurrence after liver transplantation: Risk factors, screening and clinical presentation

Cited by 101 publications

References 78 publications

Risk Factors for Hepatocellular Carcinoma Recurrence and Survival after Liver Transplantation in Patients with HCV-Related Cirrhosis

Risk Factors for Hepatocellular Carcinoma Recurrence and Survival after Liver Transplantation in Patients with HCV-Related Cirrhosis

Liver graft rejection following immune checkpoint inhibitors treatment: a review

Living donor liver transplantation for patients with advanced hepatocellular carcinoma

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