Comparative study of survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma

Figueras, Joan; Ramos, Emilio; Ibáñez, Luis; Rafecas, Antoni; Fabregat, Joan; Torras, Jaume; Lama, Carmen; Ruiz, David; Moreno, Gabriel Cánovas; Arteche, N; Jaurrieta, Eduardo

doi:10.1016/s0041-1345(99)00430-3

Cited by 72 publications

(116 citation statements)

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“…6,8,[42][43][44] Most recently, Ravaioli et al demonstrated a higher recurrence rate in early patients exceeding versus recent ones fulfilling the Milan criteria (37.5% vs. 12.7%). 29 Although these figures highlight marked improvements in outcomes achieved with careful patient selection, they show that recurrence still remains a significant threat.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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“…We considered the 3-month mortality of OLT to be 8%, according to the data published in recent series of OLT for HCC that range from 3% to 10%. 3,11,21,22 Partial Hepatectomy-Related 3-Month Mortality. We considered the 3-month mortality of partial hepatectomy to be 5%, ranging between 3% and 8%, considering that all patients had compensated cirrhosis.…”

Section: Proportion Of Patients With Hcc Developing Contraindicationsmentioning

confidence: 99%

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

et al. 2000

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Two treatments are accepted for patients with solitary hepatocellular carcinoma Յ5 cm in size and with preserved hepatic function: (1) liver resection, which can be performed without delay but has a high recurrence rate, and (2) liver transplantation, which has a better long-term survival, but is not easily available because grafts are scarce. A third possibility is to offer liver resection first and liver transplantation for tumor recurrence or deteriorating liver function (''salvage'' transplantation). We investigated the implications of such a strategy with a Markov-based decision analytic model. Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide, and its incidence is increasing in the western world because of the epidemics of the hepatitis C virus. 1 In patients aged less than 65 years, 2 therapies are currently accepted for early HCC (Յ5 cm): partial hepatectomy (PH) and orthotopic liver transplantation (OLT). 2,3 Although studies comparing the 2 treatments are retrospective and concern patients with disparate tumor characteristics and liver function, 4-6 it is agreed that OLT is preferable to partial hepatectomy in patients with hepatic insufficiency and in patients with more than 1 tumor, in whom the results of liver resection are poor.Patients with single tumors and preserved liver function present a therapeutic dilemma. Partial hepatectomy can cure the tumor immediately, with low mortality. The underlying cirrhosis, however, is responsible for a high recurrence rate, and the patient is exposed to the long-term complications of portal hypertension and hepatocellular failure. 7 OLT, by treating both the tumor and the cirrhosis, offers a better long-term survival. The tumor, however, can outgrow the criteria accepted for transplantation while waiting for donor organs, affecting the ultimate outcome as shown in a previous analysis. 2 For patients with a single resectable HCC, an alternative strategy to either partial hepatectomy or OLT would be to offer resection first and transplantation if the tumor recurs or if the liver function deteriorates (salvage OLT). Before such a strategy can be tested in a prospective controlled trial, the present study examines its implications in terms of patient outcome, graft use, and costs, using a decisional analysis model based on the data available in the literature. PATIENTS AND METHODS Decision Analytic ModelWe investigated the impact of 2 options: (1) primary liver transplantation and (2) partial hepatectomy followed by salvage liver transplantation (Fig. 1A) in patients with compensated cirrhosis and solitary HCC Յ5 cm in diameter, with a Markov simulation (Decision Maker 7

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“…Six patients required a second OLT after a median follow up of 14 months (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The reasons for retransplantation were severe rejection in 3 cases (one had also multiple biliary strictures), hepatic arterial thrombosis in 1, primary graft nonfunction in 1, and HCV related cirrhosis in 1.…”

Section: Retransplantationmentioning

confidence: 99%

Liver transplantation for small hepatocellular carcinoma: The tumor-node-metastasis classification does not have prognostic power

et al. 1998

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From a theoretical point of view, orthotopic liver transplantation (OLT) should be considered the ideal therapeutic option for patients with hepatocellular carcinoma (HCC).This neoplasm usually appears in the setting of liver cirrhosis, 1,2 and thus, OLT would eliminate the tumor and the oncogenic underlying liver. However, the first series of OLT for HCC showed disappointing results. [3][4][5][6] The inclusion of patients with advanced HCC prompted a high recurrence rate (higher than 50% at 3 years) whereas the survival rate (20%-50% at 5 years) was clearly less than that of non-HCC patients. Subsequent reports showed that HCC stage is a key point in determining the success of OLT in these patients and suggested that patients with early HCC could benefit from OLT both in terms of recurrence and survival. 5,7-10 Thereby, the recurrence rate of patients with incidental tumors which were discovered at the time of the pathological examination of the explanted liver is negligible. 3,7 Finally, two recent studies have shown that if OLT is restricted only to patients with early HCC (some years ago these tumors would have been identified only in the explanted livers), the risk of recurrence is minimal and the survival is identical to that of patients without HCC. 11,12 These encouraging data would favor OLT as the first therapeutic option to be considered in patients with HCC 13 as surgical resection is hampered by a higher recurrence rate during follow up [14][15][16][17] ; however, OLT is a highly invasive procedure with potentially severe complications in the early, medium, and long-term follow up. In addition, it must be stressed that HCC in most of the patients arises on liver cirrhosis caused by infection with HBV or HCV, 2,18 which frequently infects the graft, 19,20 and that the progression of the liver disease may be faster than in immunologically competent individuals. 21 As previously reported, 22-25 the treatment schedule applied in our Liver Unit in patients with HCC considered OLT only for those patients with solitary tumors smaller than 5 cm in whom resection was contraindicated, whereas the stage according to the TNM staging system was not taken into account. The present study analyzes the outcome of the cohort of the first 58 HCC patients submitted to OLT following this pre-established treatment algorithm, describing the accuracy of the preoperative staging, the recurrence and survival data, and also the rate of viral infection of the new liver. PATIENTS AND METHODS PatientsBetween January 1989 and December 1995, 877 patients with HCC were diagnosed, staged, and treated in our Liver Unit according to a previously published schedule. [22][23][24][25] Patients with HCC were Abbreviations: HCC, hepatocellular carcinoma; OLT, orthotopic liver transplantation; TNM, tumor-node-metastasis classification system; pTNM, pathological tumor-nodemetastasis classification.From the

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Comparative study of survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma

Cited by 72 publications

References 4 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

Primary liver resection and salvage transplantation or primary liver transplantation in patients with single, small hepatocellular carcinoma and preserved liver function: An outcome-oriented decision analysis

Liver transplantation for small hepatocellular carcinoma: The tumor-node-metastasis classification does not have prognostic power

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