LT is an effective treatment of unresectable LM from NET. Patient selection based on the aforementioned predictors can achieve a 5-year OS between 60% and 80%. However, use of overly restrictive criteria may deny LT to some patients who could benefit. Optimal timing for LT in patients with stable versus progressive disease remains unclear.

Background: Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT. Methods: A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean ± SD age was 51.3±7.5 years. Follow-up time was 61.2 ± 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied. Results: The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years (P=.04), year of LT 1995 or earlier (PϽ.05), duration of abstinence less than 6 months (P= .02), presence of psychiatric comorbidities (PϽ.001), presence of a life partner (PϽ.05), and a high score on the High-Risk Alcoholism Relapse (HRAR) scale (PϽ.001). Mul-tivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.2-9.3) (P =.02); presence of psychiatric comorbidities (OR, 7.8; 95% CI, 3.1-20.0) (PϽ.001); and HRAR score higher than 3 (OR, 10.7; 95% CI, 3.8-30.0) (P=.001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively. Conclusions: In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined.

Liver steatosis is a frequent late complication of LT; its development depends on a combination of host and graft factors. LT is therefore an interesting model to study the natural history and the determinants of liver steatosis.

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OLT can achieve control of hormonal symptoms and prolong survival in selected patients with liver metastasis of carcinoid tumors. It does not seem indicated for other NET.

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-