Predictors of Outcome of Living Donor Liver Transplantation for Hepatocellular Carcinoma

Abstract

The aim of this work is to study the different factors that affect the outcome of living donor liver transplantation for patients with hepatocellular carcinoma (HCC). Between April 2003 to November 2014, 62 patients with liver cirrhosis and HCC underwent living donor liver transplantation (LDLT) in the National Liver Institute, Menoufia University, Egypt. The preoperative, operative, and postoperative data were analyzed. After studying the pathology of explanted liver; 44 (71 %) patients were within the Milan criteria, and 18 (29 %) patients were beyond Milan; 13 (21.7 %) of patients beyond the Milan criteria were also beyond the University of California San Francisco criteria (UCSF) criteria. Preoperative ablative therapy for HCC was done in 22 patients (35.5 %), four patients had complete ablation with no residual tumor tissues. Microvascular invasion was present in ten patients (16 %) in histopathological study. Seven (11.3 %) patients had recurrent HCC post transplantation. The 1, 3, 5 years total survival was 88.7, 77.9, 67.2 %, respectively, while the tumor-free survival was 87.3, 82.5, 77.6 %, respectively. Expansion of selection criteria beyond Milan and UCSF had no increased risk effect on recurrence of HCC but had less survival rate than patients within the Milan criteria. Microvascular invasion was an independent risk factor for tumor recurrence.

Life Expectancy after Liver Transplantation for Non-Cirrhotic Hepatocellular Carcinoma

“…The 7 tumor related factors, especially lymph node involvement, vascular invasion, and poor tumor differentiation, were significantly related to survival, with large hazard ratios and correspondingly large effects on life expectancy. These findings mirror those of Worns et al 28 Zakaria et al, 4 and Mergental et al 3…”

“…Two more recent studies bear mention. Zakaria et al 4 reported 1- and 5-year rates of 89% and 67% in 62 Egyptian patients transplanted in 2003 to 2014, with average age 49, and Mehta et al 5 reported 95% and 80% in 187 California patients of median age 58. Comparisons of this type are admittedly tentative, however, as they are may be confounded by differences in ( a ) era of transplant, ( b ) age and other demographics, ( c ) medical and tumor-related risk factors, and ( d ) various study selection criteria.…”

“…A 5-year study by Mergental et al 3 identified 105 European patients with unresectable NC-HCC, where transplantation was the primary treatment in 62 patients (59%) and was the rescue therapy in the other 43 (41%); only 12 initially met the Milan criteria. The authors identified factors related to survival, but did not report life expectancies nor stratify results by age or other factors, nor did Zakaria et al 4 or Mehta et al 5…”

Risk factors and management of incisional hernia in the recipients of living donor liver transplant: A single institutional experience

“…Liver transplant (LT) has progressed in the past century from a life‐saving operation with a high morbidity and mortality to a standardized procedure with high success rate and reported 1‐year survival rate of more than 90%. However, surgical complications, such as biliary complications and incisional hernia (IH), are common with this complex procedure 1‐3 …”

“…IH forms not only an aesthetic problem, but they may also reduce the quality of life and can lead to serious morbidity due to incarceration or strangulation. Therefore, the prevention of this late complication has become increasingly important 3‐5 …”