Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: Clinical patterns and outcome variables

Kornberg, Arno; Küpper, B.; Tannapfel, Andrea; Katenkamp, Kathrin; Thrum, Katharina; Habrecht, O.; Wilberg, J.

doi:10.1016/j.ejso.2009.10.001

Cited by 122 publications

(142 citation statements)

References 31 publications

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“…8,21,22 The risk of developing tumor recurrence is the main argument against expanding eligibility criteria. 13,23,24 In a recent metaanalysis of 74 studies by Germani and associates, the authors found that patients receiving LT beyond the Milan criteria have increased risk of recurrence and worse overall survival, which includes an increased risk of death if transplanted outside the Milan criteria, but within the more inclusive UCSF criteria. 25 Therefore, relaxing the tight parameters defined in the Milan criteria on pre-LT tumor size adversely affects post-LT outcomes.…”

Section: Pretransplant-prevention Of Hepatocellular Carcinoma Recurrementioning

confidence: 99%

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Rubin

Ayoub²,

Kaldas³

et al. 2012

Exp Clin Transplant

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Hepatocellular carcinoma is the most common form of liver cancer, representing 70% to 85% of primary hepatic malignancies in adults. Liver transplant is an optimal treatment for patients with hepatocellular carcinoma because it eliminates the malignancy as well as the oftenunderlying liver cirrhosis and restores normal liver function. Since the development of strict selection criteria in hepatocellular carcinoma patients undergoing liver transplant with the implementation of the Milan criteria, patient survival and recurrence rates after liver transplant have dramatically improved. However, several research groups are now seeking to expand this criteria to include more patients with larger tumors who may achieve similar postliver transplant survival rates as those patients meeting current eligibility requirements. Currently, in approximately 20% of patients, hepatocellular carcinoma recurrence is still the rate-limiting event that clearly affects patient survival.Given the limited number of grafts available for transplant, the poor prognosis of untreated hepatocellular carcinoma, and the recent notion of expanding selection criteria, strategies for reducing the rate of, monitoring and treating hepatocellular carcinoma recurrence, in both pretransplants and posttransplants, are explored in this review. We review the available literature to better understand current strategies available to optimize long-term clinical outcomes.

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Section: Pretransplant-prevention Of Hepatocellular Carcinoma Recurrementioning

confidence: 99%

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Rubin

Ayoub²,

Kaldas³

et al. 2012

Exp Clin Transplant

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“…There is indirect evidence for a tumor biology explanation: vascular invasion was found during the original explant pathology examination in only 3 of 7 patients with surgically resectable recurrence but in all 9 patients whose recurrence pattern was unsuitable for surgery in 1 study. 8 Liver resection after transplantation for a variety of indications, including recurrent HCC, has been shown to be safe. 10 The literature concerning the results of surgical treatments for HCC recurrence is summarized in Table 2.…”

Section: Resection/radiofrequency Ablationmentioning

confidence: 99%

Treatment of recurrent hepatocellular carcinoma after liver transplantation

et al. 2011

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“…In a study from Japan, resection led to better outcomes than RFA for recurrent HCC after LT [134] and can be performed safely [135]. The presence of vascular invasion in the original explant reduced chances of complete resection in the event of recurrence [136]. The use of TACE for post-LT recurrences is well-tolerated but has not shown to provide superior outcomes to RFA.…”

Section: How Should Recurrences Be Monitored and Managed After Transpmentioning

confidence: 99%

Liver Transplantation for HCC: A Review

Kakodkar¹,

Soin²

2011

Indian J Surg

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Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit. Selection criteria have considered tumor size, number, volume as well as biological features. The Milan criteria set the benchmark for tumors that would benefit from liver transplantation but were found to be excessively restrictive. Modest expansion in criteria has also been shown to be associated with equivalent survival. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Downstaging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success.

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Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: Clinical patterns and outcome variables

Cited by 122 publications

References 31 publications

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Treatment of recurrent hepatocellular carcinoma after liver transplantation

Liver Transplantation for HCC: A Review

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