Multicenter Italian Experience in Liver Transplantation for Hepatocellular Carcinoma in HIV-Infected Patients

Abstract

Learning Objectives Compare clinical outcomes following liver transplant for heptaocellular carcinoma in patients with and without HIV infection. Identify predictors of mortality following liver transplant for heptaocellular carcinoma in patients with and without HIV infection.

Non-AIDS definings malignancies among human immunodeficiency virus-positive subjects: Epidemiology and outcome after two decades of HAART era

“…Overall survival and relapse rate were not significantly different among HIVpositive patients with HCC compared to HIVnegative control group. This data were recently confirmed by Di Benedetto et al [54] , who recently compared the outcome of 30 HIVpositive patients who underwent LT with 125 HIVnegative patients: at 1 year and 3 years post LT overall survival (77% at 1 years AIDS Clinical Trial Group (ACTG), which used the ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine), more intensive chemotherapy regimens including BEACOPP (bleomycine, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone), Stanford V (mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, prednisone), and VEBEP (epirubicine, bleomycin, vinorelbine, cyclophosphamide and prednisone) with radiotherapy have been proposed, and a complete remission (CR) rate > 60% has been obtained [6366] . Combined administration of HAART and chemotherapy showed to reduce the risk of opportunistic infections, relapses and to improve the CR rate.…”

The Evolving Role of Local Treatments for HCC in the Third Millennium

“…As previously reported, the absence of active residual HCC in the native liver at histological examination after liver transplantation in patients who had undergone bridging therapies was a highly positive prognostic factor in regard to HCC recurrence and overall patient survival (50). Moreover, an aggressive treatment of HCC with liver resection, TACE, and RFA is necessary for down-staging and is able to qualify patients for transplant (51). Later in 2015, in a prospective study Wang and colleagues reported that in patients treated for recurrence after curative hemi-hepatectomy, the repeat hepatectomy group had significantly better overall survival and RTDS than the RFA group, and that of the RFA group was significantly better than that of the TACE group (36).…”

Liver transplantation for hepatitis C virus in the era of direct-acting antiviral agents

“…A case-control study of patients with HCC and listed for liver transplantation comparing HIV-infected patients (n ¼ 21) and non-HIV-infected patients have shown a higher dropout rate due to tumor progression (23% versus 10%), a lower survival on waiting list and a higher post-liver transplantation HCC recurrence (30% versus 15%) in HIV patients [13]. Nevertheless, these results have not been confirmed in a recent comparative study, showing similar survival rates and HCC recurrence rates among 30 HIV patients compared with 125 controls [12]. Taken together, prospective studies are absolutely mandatory to provide robust data concerning optimal criteria for HIV patients with HCC [14 & ].…”

“…HIV patients are no exception [12]. In most countries, Milan criteria remain the cornerstone to indicate a liver transplantation in a context of HCC (1 HCC 5 cm, or !3 nodules 3 cm, with no vascular invasion or metastatic disease).…”