The Outcome of Liver Transplantation in Patients With Hepatocellular Carcinoma in the United States Between 1988 and 2001: 5-Year Survival Has Improved Significantly With Time

Yoo, Hae Young; Patt, Cary H.; Geschwind, Jean François H.; Thuluvath, Paul J.

doi:10.1200/jco.2003.11.137

Cited by 233 publications

(154 citation statements)

References 32 publications

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“…These rates reflect significant improvement over earlier results, most prominently due to a more judicious patient selection based on defined HCC criteria. 45 Such favorable dropout, recurrence, and survival rates were observed despite the inclusion of 10 patients whose tumor burden surpassed the Milan criteria. In fact, 9 of the 10 patients were successfully bridged to transplantation.…”

Section: Discussionmentioning

confidence: 94%

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation†

et al. 2005

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Section: Discussionmentioning

confidence: 94%

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation†

et al. 2005

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“…However, other noncomparative studies have reported that the 5-year survival rates of HCC patients have improved with time, and these improvements started with the implementation of the MC in the clinical practice. 103 …”

Section: And Nontumor Indicationsmentioning

confidence: 99%

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Mazzaferro

Bhoori²,

Sposito³

et al. 2011

Liver Transpl

509

322

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“…1 We present an unusual case of an LT recipient with gradually rising alpha-fetoprotein (AFP) levels who was eventually diagnosed with metastatic HCC to the right ventricle.…”

Section: To the Editorsmentioning

confidence: 99%

“…1 We present an unusual case of an LT recipient with gradually rising alpha-fetoprotein (AFP) levels who was eventually diagnosed with metastatic HCC to the right ventricle.A 57-year-old man with hepatitis C cirrhosis underwent chemoembolization for a 2.0-cm HCC lesion and then deceased donor LT in 2004. His AFP level at the time of LT was 610 ng/mL, and the explant showed 3 lesions (all < 2 cm) with microvascular invasion.…”

mentioning

confidence: 99%

Find it in your heart

Kia

Mulcahy²,

Levitsky

2013

Liver Transpl

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TO THE EDITORS:Recurrence of hepatocellular cancer (HCC) after liver transplantation (LT) is uncommon (<10%). 1 We present an unusual case of an LT recipient with gradually rising alpha-fetoprotein (AFP) levels who was eventually diagnosed with metastatic HCC to the right ventricle.A 57-year-old man with hepatitis C cirrhosis underwent chemoembolization for a 2.0-cm HCC lesion and then deceased donor LT in 2004. His AFP level at the time of LT was 610 ng/mL, and the explant showed 3 lesions (all < 2 cm) with microvascular invasion. His immediate post-LT AFP level was 2.8 ng/mL, and it remained normal until 2007 when it rose to 400 ng/ mL; chest imaging demonstrated a 3.2-cm lung mass. With no other metastases, he underwent lung resection. His AFP level remained low thereafter (nadir 5 18 ng/mL) but began to increase in 2009 to a peak of 1631 ng/mL in 2012. Within this period, there was no evidence of recurrent HCC on multiple chest, abdomen, pelvis, and bone scan examinations. In mid-2012, echocardiography before sinus surgery revealed a 4.8-cm right ventricular free wall echodensity (Fig. 1). On cardiac magnetic resonance imaging, the mass was isointense and lacked enhancement, this strongly favoring malignancy (Fig. 2). Tissue biopsy was deferred because of this imaging, the elevated AFP level suggesting HCC, and the risk of embolization. No other metastases were found. He was treated with sorafenib (400 mg twice daily), but his AFP level has been progressively rising.The case presented a diagnostic dilemma because the AFP level was slowly increasing over years without evidence of recurrent HCC. Because the AFP level is increased in approximately 70% of HCC cases before LT, it is perhaps more useful than imaging for serially monitoring patients for recurrence after LT. This is particularly true if the AFP level normalizes and subsequently increases after LT. 2 The typical sites (ie, the lungs, liver, adrenal glands, lymph nodes, and bone) were not involved in this case, nor was the hepatic vein or inferior vena cava. Thus, this represented a true cardiac hematogenous metastasis, which is rare Figure. 1. A 4-chamber view of the heart from 2-dimensional echocardiography demonstrates a large spherical echodensity (4.8 cm 3 2.7 cm) arising from the right ventricular free wall and occupying the right ventricular cavity. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] Figure. 2. An axial image from cardiac magnetic resonance imaging shows a 3.2 cm 3 5.2 cm 3 4 cm mass that appears adherent to the inferior wall of the right ventricle and demonstrates an isointense signal to the myocardium. Address reprint requests to

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The Outcome of Liver Transplantation in Patients With Hepatocellular Carcinoma in the United States Between 1988 and 2001: 5-Year Survival Has Improved Significantly With Time

Abstract: Five-year survival of patients transplanted for HCC is excellent, with a steady improvement in survival over the past decade. It is possible that the published criteria for patient selection may have contributed to the better outcome.

Cited by 233 publications

References 32 publications

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation†

Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation†

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

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