Liver transplantation for hepatocellular carcinoma: the Baylor experience

Abstract

Results Of 2350 patients who underwent primary LTX, 330 had HCC. Five-year patient survival for HCC patients was 28.6% in 1987-1992 and 42.3% in 1992-1997, which was 41.4-31.4% lower than that in non-HCC patients (P \ 0.0001). After 1997, 5-year survival was 76% for HCC patients, similar to the survival for non-HCC patients (P = 0.8784). Five-year tumor recurrence dropped from 52. 9% (1987-1992) and 48.2% (1992-1997) to 11.4% (1997-2002) and 8.4% (2002-2007) (P \ 0.0001). Multivariate analysis for tumor recurrence showed the following significant factors: tumor size [6 cm [hazard ratio (HR) 3.67], C5 nodules (HR 3.441), vascular invasion (HR 3.18), transplant in 1987-1992 (HR 6.772), and transplant in 1992-1997. MELD-based liver allocation reduced median waiting time for LTX for HCC versus non-HCC (35 vs. 111 days; P = 0.005) without compromise in patient outcome. Conclusions The results of LTX for HCC continue to improve and are equal to results in patients without HCC.

Liver transplantation in septuagenarians receiving model for end-stage liver disease exception points for hepatocellular carcinoma: The national experience

“…Although the increase in preoperative comorbidities is notable, under certain conditions, these do not appear to influence the rate of postoperative complications or hospital mortality 62‐64. Recent studies have also concluded that older patients with HCC frequently harbor tumors with a higher degree of encapsulation; this factor has portended a higher degree of tumor differentiation and less vascular invasion,62 which are characteristics known to influence outcomes in the transplant setting 3, 5, 65‐70. Despite an overall increased prevalence of HCV, seniors also have a lower frequency of hepatitis B surface antigen positivity 62, 63.…”

“…Although previous studies may have indicated a greater disparity in outcomes between HCC and non‐HCC cohorts,8, 21, 83, 84 many incorporated data obtained before the adoption of contemporary rules for organ allocation, and thus may be reflective of historical waiting times and patient selection practices. As for liver transplantation for HCC, the improvement in overall patient and disease‐free survival accumulated in the MELD era is clearly underscored by 2 large, contemporary series published by the Baylor70 and University of California Los Angeles programs,13 respectively.…”

“…However, our figures corroborate recent data indicating that the majority of individuals with HCC in the contemporary MELD era fall within the Milan criteria85 and are thus comparable in stage. In addition to the standard Milan criteria, vascular invasion has consistently emerged in multivariate analyses as an unequivocal prognostic factor for survival after resection and transplantation 13, 65, 69, 70, 76, 86‐89. For HCC patients who exceed the Milan criteria, more than 311, 76, 90 and sometimes more than 5 distinct tumor foci70 have been implicated as factors affecting outcomes after transplantation.…”

“…In addition to the standard Milan criteria, vascular invasion has consistently emerged in multivariate analyses as an unequivocal prognostic factor for survival after resection and transplantation 13, 65, 69, 70, 76, 86‐89. For HCC patients who exceed the Milan criteria, more than 311, 76, 90 and sometimes more than 5 distinct tumor foci70 have been implicated as factors affecting outcomes after transplantation. Discrete lesion sizes greater than 5,70, 76 6,11 and 6.5 cm 90 along with total tumor burdens at times exceeding 8 cm 90 have likewise been reported.…”

“…For HCC patients who exceed the Milan criteria, more than 311, 76, 90 and sometimes more than 5 distinct tumor foci70 have been implicated as factors affecting outcomes after transplantation. Discrete lesion sizes greater than 5,70, 76 6,11 and 6.5 cm 90 along with total tumor burdens at times exceeding 8 cm 90 have likewise been reported. Other factors associated with decreased overall patient and disease‐free survival include excessive alpha‐fetoprotein elevations3, 65, 90 and histological grades 13, 65, 76.…”