ComplicationTumor Recurrence After Liver Transplantation for Hepatocellular Carcinoma: Recurrence Pathway and Prognostic Factors
Section snippets
Study Time and Patients
From June 1989 to December 2003, with follow-up finished in September 2004 (mean follow up of 44.2 ± 41.7 months), we performed 961 OLTs including 9.8% in patients with HCC (n = 95). The male/female ratio was 74 (72.9%) to 21 (22.1%) with an overall mean age of 54.7 ± 8.7 years (range 15 to 70).
Functional Status and Preoperative Variables
Most patients were Child B (45.1 %, n = 41) or C (36.3%, n = 33). Preoperative transarterial chemoembolization was performed in 31 patients (33.7%) while on the waiting list. The mean alpha fetoprotein
Long-Term Survival
At the end of the study 56 of the 87 patients were alive (64.4%) with 1-, 3-, and 5-year actuarial survivals of 85%, 68.7%, and 60.2%, respectively, and a mean survival time of 122.1 ± 13.6 months. The 1-, 3-, and 5-year disease-free survivals (DFS) were 81%, 65%, and 57%, respectively with a mean DFS time of 114 ± 14.2 months.
During the follow-up the main cause of mortality was tumor recurrence (35.5%) and medical causes (29%). Six patients (19.4%) died due to liver disease recurrence and 5
Discussion
OLT is the management of choice for HCC and liver cirrhosis with good long-term outcomes longer survivals and lower recurrence incidences than liver resection especially with the application of Milan criteria: namely, a solitary tumor below 5 cm or no more than three nodules no larger than 3 cm3. With the application of these selection criteria, the recurrence incidence has decreased to 10% to 20%.1, 2, 3, 4 In this series, we observed a recurrence incidence of 15.8%, but it was an historical
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