Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation

Abstract

Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants. Methods. We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma. Results. Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P < 0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P = 0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P = 0.016). Conclusions. iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.

Incidental Hepatocellular Carcinoma after Liver Transplantation: Clinicopathologic Features and Prognosis

“…We think that the appearance of macronodular cirrhosis in the imaging of Budd–Chiari patients may increase the rate of iHCC by superposing small tumors. In the previous reports, HCV hepatitis is higher in iHCC patients [ 10 , 11 ]. Although we cannot explain the reason with strong evidence-based data, it is the first study to show that iHCC patients may differ from pdHCC patients in terms of etiological features.…”

“…Various prevalence rates were reported for iHCC (4.2% to 40%) [ 5 , 6 , 7 , 8 , 9 ]. Different prognostic factors of iHCC were reported in the previous studies [ 7 , 10 , 11 ]. In some studies, there is no prognostic effect either in disease-free survival (DFS) or in overall survival (OS); on the other hand, a worse prognostic effect can be observed in iHCC patients than “preoperatively diagnosed HCC” (pdHCC) groups [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“…Different prognostic factors of iHCC were reported in the previous studies [ 7 , 10 , 11 ]. In some studies, there is no prognostic effect either in disease-free survival (DFS) or in overall survival (OS); on the other hand, a worse prognostic effect can be observed in iHCC patients than “preoperatively diagnosed HCC” (pdHCC) groups [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. We aimed to compare the clinicopathologic and prognostic features of pdHCC and iHCC patients who received LT at the Inonu University Liver Transplantation Institute.…”

Prognosis of Hepatocellular Carcinoma after Liver Transplantation: Comparative Analysis with Partial Hepatectomy

“…Pretransplant tumor staging and explant pathology do not always correlate, and 83 of 145 cases (57%) within the Milan criteria were classified as “beyond Milan” based on the presence of angioinvasion in microscopic findings. There might be discrepancies in the size or number of tumors between the pre-transplant radiological staging and explant pathologic staging [ 24 , 25 ]. Therefore, further studies to reduce the preoperative and postoperative staging are needed.…”