Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry

Abstract

Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly under

Impact of everolimus on survival after liver transplantation for hepatocellular carcinoma

“…The result after PSM showed a more dramatic improvement in the survival rate of the EVR group compared to the Non-EVR group. MiVI has been identified as one of the strongest risk factors for poor outcomes after LT. 11,30 Lim et al 10 argued that MiVI is a better predictor of tumor recurrence and OS in HCC than Milan criteria. However, MiVI can only be detected by pathologic examination after LT, and no evidence currently indicates that postoperative adjuvant therapy provides a survival benefit after LT for HCC in patients with pathologically confirmed MiVI.…”

Non-cirrhotic hepatocellular carcinoma in chronic viral hepatitis: Current insights and advancements

“…If similar risk exists for NCHCC is unclear. Additionally, NCHCC can exhibit more genomic variants, suggestive of a separate tumor biology in these patients[ 38 , 39 ]. Further, HBV-human immunodeficiency virus (HIV) coinfection has been reported to cause higher risk of HCC (OD 7.1, 95%CI: 2.8-17.9)[ 40 ].…”

“…Few studies in the past debated if tumor size along predicts survival in these patients. Pommergaard et al [ 39 ] studied 22787 HCC patients from European Liver Transplant Registry transplanted between 1990 and 2016 and noted that HCC in non-cirrhotic livers had similar overall mortality (adjusted HR 1.11, 95%CI: 0.99-1.25), but higher HCC-specific mortality (adjusted HR 1.62, 95%CI: 1.31-2); perhaps due to a more aggressive biology of the tumors in the non-cirrhotic livers. NCHCC patients were younger, had lower MELD scores and higher risk of microvascular invasion and received more locoregional treatment.…”

“…On patients beyond the established criteria, novel surgical approaches can be pursued, such as living donor transplantation, split transplantation or the use of marginal grafts, such as donation after circulatory death allografts[ 109 ]. On non-cirrhotics, macrovascular invasion and extrahepatic spread are the only recommended exclusion criteria for LT[ 39 ]. As per Mazzaferro et al [ 108 ] if transplanted within Milan criteria, the four-year actuarial survival is 76%, and the recurrence free survival 83%.…”

“…The recurrence risk increases if the pre-transplant lesions is higher: 78% recurrence is noted with lesions higher than 8 cm compared to 40% with 4-8 cm lesions[ 110 , 111 ]. Higher NCHCC recurrence may reflect more advanced tumors and multicentric carcinogenesis[ 39 , 112 ].…”