Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy

Shao, Zhuo; López, Rocío; Shen, Bo; Yang, Guang

doi:10.3748/wjg.14.4370

Cited by 16 publications

(20 citation statements)

References 30 publications

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“…The remaining 16 articles were included for this review, as outlined in the PRISMA flow diagram (Fig. ) . None of the studies reviewed were randomized trials.…”

Section: Resultsmentioning

confidence: 99%

“…1). [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] None of the studies reviewed were randomized trials. There was a combination of class II (nonrandomized comparative or well-designed cohort studies) and class III (observational studies) evidence in the available literature.…”

Section: Resultsmentioning

confidence: 99%

“…The rate of SLT following recurrence was 41% (range 16-65%) ( Table 5). Adam et al 20 2003 21 2009 22 2008 23 2013 25 2012 26 2007 27 2012 Japan 28 2008 29 2012 30 2012 South Korea Class 31 2008 Hong Kong Class 32 2010 33 2008 34 2007 35 2012…”

Section: Recurrence and Recurrent Disease Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of efficacy and outcomes of salvage liver transplantation after primary hepatic resection for hepatocellular carcinoma

Chan

Alzahrani

Morris

et al. 2013

J of Gastro and Hepatol

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“…The remaining 16 articles were included for this review, as outlined in the PRISMA flow diagram (Fig. ) . None of the studies reviewed were randomized trials.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of efficacy and outcomes of salvage liver transplantation after primary hepatic resection for hepatocellular carcinoma

Chan

Alzahrani

Morris

et al. 2013

J of Gastro and Hepatol

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“…According to the Barcelona Clinic Liver Cancer (BCLC) approach, resection is the treatment of choice in patients with limited tumor size and normal bilirubin levels as well as absence of portal hypertension [22]. In these patients, rescue OLT is feasible in case of recurrent or de novo liver cancer fulfilling the Milan criteria [23]. In contrast, in patients with (very) early stage HCC, but impaired liver function, OLT is recommended as primary treatment approach [24].…”

Section: Risk Factors For Recurrencementioning

confidence: 99%

Recurrent hepatocellular carcinoma after liver transplantation - an emerging clinical challenge

et al. 2012

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Summary In western countries, hepatocellular carcinoma (HCC) is a major reason for orthotopic liver transplantation (OLT) with estimated recurrence rates between 15% and 20%. This selective literature review addresses follow‐up care after OLT in HCC and current treatment options. Recurrence prediction is based on pathological tumor stage, vascular invasion, serum alfafetoprotein levels, and histological differentiation, but further advances are expected by molecular profiling techniques. Lower levels of immunosuppressive agents are associated with a lower risk for HCC recurrence. Retrospective studies indicate that mammalian target of rapamycin (mTOR) inhibitors as immunosuppression reduce the risk of HCC recurrence. However, prospective studies supporting this potential advantage of mTOR inhibitors are still lacking, and higher rejection rates were reported for sirolimus after OLT in HCC. Prognosis is poor in recurrent HCC, a longer interval between OLT and recurrence and feasibility of surgical resection are associated with improved survival. Systemic treatment with sorafenib is the current standard of care in patients with advanced‐stage HCC not suitable for locoregional therapy. After OLT, combination of an mTOR inhibitor with sorafenib is feasible and frequently used in clinical practice. As safety and efficacy data are still limited, close clinical monitoring is mandatory.

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“…In an attempt to promote LR as the first‐line treatment with curative intention, salvage transplantation following LR in cases of disease recurrence has been widely adopted . The initial reports by Majno et al and Poon et al were followed by several contributions . Initial concerns regarding the technical difficulties of LT after LR were discarded, and a recent meta‐analysis evaluating the outcomes of this strategy confirmed that salvage LT following primary LR is a highly applicable strategy with long‐term survival outcomes that are comparable to upfront LT …”

mentioning

confidence: 99%

Prospective validation of ab initio liver transplantation in hepatocellular carcinoma upon detection of risk factors for recurrence after resection

et al. 2016

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A decade ago we proposed to enlist for transplantation those patients with resected hepatocellular carcinoma in whom pathology registered pejorative histological markers (microvascular invasion and/or satellites; ab initio indication) and not wait for the appearance of recurrence. This study evaluates the outcome of this approach. From 1995 to 2012, 164 patients with hepatocellular carcinoma underwent resection. Eighty-five patients were potential candidates for liver transplantation and were considered for it upon detection of pejorative histological markers. Patients without these markers were followed, and salvage liver transplantation was considered upon development of tumor recurrence/liver function impairment. Thirtyseven patients were at high risk and 48 at low risk of recurrence at pathology. Twenty-three out of 37 high-risk patients recurred during follow-up, but in nine of them the tumor burden extent contraindicated liver transplantation. Seventeen were finally transplanted: 10 of them presented recurrence at imaging/explant. After a median posttransplant follow-up of 50.9 months, hepatocellular carcinoma had recurred in two patients and five patients had died, the 5-year survival being 82.4%. Twenty-six of the 48 low-risk patients developed recurrence, and 11 of them were transplanted. After a median posttransplant follow-up of 59 months, two patients developed recurrence and five died, their 5-year survival being 81.8%. Conclusion: Enlistment of patients at high risk of HCC recurrence after resection but before recurrence development seems a valid strategy and is associated with excellent long-term outcome; as early (<6 months) recurrence reflects an aggressive tumor behavior leading to tumor extent exceeding transplant criteria, we propose to wait at least 6 months before enlistment; however, once included on the waiting list, priority strategies should be implemented in order to reach effective transplantation prior to the appearance of recurrence. (HEPATOLOGY 2016;63:839-849) H epatocellular carcinoma (HCC) is the most common primary tumor of the liver. The incidence of HCC is increasing in the United States and Europe, and it is currently the third leading cause of cancer-related death globally.(1,2) Liver transplantation (LT) is theoretically the treatment of choice because it allows removal not only of the tumor but also of the underlying cirrhosis. It offers a high survival rate and a low recurrence rate in well-selected cases. (3,4) Although Spain has the highest rate of

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Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy

Cited by 16 publications

References 30 publications

Systematic review of efficacy and outcomes of salvage liver transplantation after primary hepatic resection for hepatocellular carcinoma

Systematic review of efficacy and outcomes of salvage liver transplantation after primary hepatic resection for hepatocellular carcinoma

Recurrent hepatocellular carcinoma after liver transplantation - an emerging clinical challenge

Prospective validation of ab initio liver transplantation in hepatocellular carcinoma upon detection of risk factors for recurrence after resection

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