No abstract

Patients undergoing surgery for IHCC are at high risk of R1 resections. In pN0 patients, R1 resection is the strongest independent predictor of poor outcome and a margin of at least 5 mm should be created. The survival benefits of resection in pN+ patients and R1 resection in general are very low.

Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.

End-stage liver disease caused by hepatitis C virus (HCV) units 3 times weekly) and oral ribavirin (1,200 mg/d) for a infection has become the most common indication for orduration of 6 months, followed by maintenance with ribavirin thotopic liver transplantation (OLT). The resurgence of HCV alone for an additional 6 months. Twenty-one liver transplant following transplantation is characterized early on by the recipients with recurrent hepatitis C infection (HCV-RNA-detection of HCV-RNA in serum and liver. The natural hispositive; active hepatitis without rejection on biopsy) were tory and long-term outcome of HCV recurrence following enrolled in this study. Pretreatment serum alanine transami-OLT remain uncertain. The histological consequences of nase (ALT) levels were at least two times the upper limit of HCV infection are more severe in patients after OLT than in normal. Before treatment, all patients were HCV-RNA-posi-nonimmunosuppressed subjects.1 Indeed, over 50% of liver tive and mean HCV-RNA titers were 125 million genome-transplant patients develop chronic active hepatitis after two equivalents/mL. Mean pretreatment histological score was 6.3 years; 2 subsequent progression to cirrhosis threatens graft { 2. After 6 months of combination therapy, all 21 patients function and patient survival.3 Currently, no effective prehad normal ALTs. Ten patients (48%) cleared HCV-RNA from ventive or therapeutic interventions are available to halt this their serum, as assessed by polymerase chain reaction (PCR), progressive deterioration of the graft. and HCV-RNA levels decreased significantly in the others (P The mechanisms of HCV-induced liver damage after trans-Å .0001). Improvement in histological score was seen in all plantation are poorly understood. Immunosuppression is patients after combination therapy (P Å .0013). During main-likely a major factor, because it is associated with a dramatic tenance ribavirin monotherapy, ALT remained normal in all increase of viral replication resulting in high-circulating but 1 of the 18 patients who tolerated therapy. HCV-RNA HCV-RNA levels, 16-fold higher than pretransplant values. 4 reappeared in 5 patients, but HCV-RNA levels did not return It also has been suggested that infection by genotype 1b (the to pretreament levels (P Å .0004). Comparison of pretreat-most common in this setting) has a more aggressive course ment and postribavirin monotherapy liver biopsies revealed following transplantation and that this occurs independently improvement in all but 1 of the 18 patients who tolerated of the viral burden. 5 ribavirin (P Å .0002). Side effects were restricted to anemia, Because high HCV-RNA titers and HCV 1b genotype are which necessitated cessation of ribavirin therapy in 3 patients. two of the unfavorable predictors for the lack of response to No patient experienced graft rejection during the study pe-interferon alfa (IFN-a) therapy, 6-7 it is not surprising that riod. These results are significantly better than those reported IFN-a has not been found to be effectiv...

The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre-and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 ؎ 3.2 months in the TACE group and 4.3 ؎ 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre-and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis >80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P ‫؍‬ 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival. (Liver Transpl 2005;11:767-775.) H epatocellular carcinoma (HCC) is one of the most common cancers, and its incidence is rising worldwide. 1-3 HCC occurs usually in cirrhotic livers and less than 30% of cases qualify for resection. 4 Liver transplantation (LT) is the only potentially curative treatment for patients with HCC and cirrhosis. The 5-year survival rate of patients after LT ranges from 33% to 74%, depending on the tumor stage. When LT for HCC is restricted to patients with tumors meeting the widely used Milan criteria, 5 the 5-year overall survival rate is 70% and the recurrence rate is below 15%. [5][6][7] Lengthy waiting periods due to a shortage of donors can allow the tumor to progress to stages that may contraindicate LT. As reported by Yao et al., 8 a 6-month waiting period is associated with a 7.2% cumulative dropout probability, and this rate rises to 37.8% and 55.1% at 12 and 18 months, respectively. Such patients are often offered treatments aimed to control tumor growth pending LT in order to reduce the dropout rate and to improve survival after trans-