Recurrent hepatocellular carcinoma after liver transplant: identifying the high-risk patient

Nissen, Nicholas N.; Menon, Vijay G.; Bresee, Catherine; Tran, Tram T.; Annamalai, A.; Poordad, Fred; Fair, Jeffrey H.; Klein, Andrew S.; Boland, Brendan; Colquhoun, Steven D.

doi:10.1111/j.1477-2574.2011.00342.x

Cited by 23 publications

(24 citation statements)

References 12 publications

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“…Recurrent hepatocellular carcinoma has a 10e18% incidence and develops at a median time interval of 14e25 months following liver transplantation. 49,50 Infections Immunosuppression increases the susceptibility to infections in the post-transplant period. Intestinal transplant recipients are more susceptible to infections than recipients of other forms of abdominal organ transplantation.…”

Section: Intestinal Complicationsmentioning

confidence: 99%

Extravascular complications following abdominal organ transplantation

2015

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Section: Intestinal Complicationsmentioning

confidence: 99%

Extravascular complications following abdominal organ transplantation

2015

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“…[2][3][4] Liver transplant (LT) remains the most effective treatment for earlystage HCC. 5 Nearly one-quarter of all adult LT recipients were transplanted for HCC in the United States. 6 Liver transplant is only indicated in HCC patients at early stages, but unfortunately some patients are diagnosed with locally advanced or metastatic stage.…”

Section: Introductionmentioning

confidence: 99%

“…7 Patients who are transplanted for HCC are at risk for recurrence after transplant. 5,8 Although the liver containing HCC is replaced with a healthy one, most patients will continue to carry on the existing predisposing factors. 6,[9][10][11][12] In addition, post-LT immunosuppressive medications increase the risk of HCC recurrence, as well as tumor progression.…”

Section: Introductionmentioning

confidence: 99%

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Jakhete

Saberi²,

Jonassaint³

et al. 2016

Exp Clin Transplant

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Objectives: Curative therapy for hepatocellular carcinoma is liver transplant. To date, the Milan Criteria remain the best pretransplant clinical surrogate for tumor behavior and overall prognosis. Microvascular invasion portends a poor prognosis; however, it is often undetectable before transplant. Furthermore, its pretransplant indicators are not well established. In this study, we investigated the presurgical and pathologic predictors of microvascular invasion in patients with hepatocellular carcinoma. Materials and Methods: Between August 2000 and August 2013, 156 liver transplants were performed for hepatocellular carcinoma at the Johns Hopkins Medical Center. Information on clinical characteristics and pathology data, including microvascular invasion, were available for 107 patients on liver explants. Logistic regression was used to assess the effects of Milan Criteria, alpha-fetoprotein, tumor differentiation, and multilobar involvement on the presence of microvascular invasion on explant pathology. Results: In 107 patients, 24 (22%) had microvascular invasion on pathology. In patients with microvascular invasion, 41% were outside of Milan Criteria versus 19.3% of patients within but without microvascular invasion. In patients with microvascular invasion, the rate of poor differentiation and alpha-fetoprotein level > 1000 ng/mL were more common than in patients without microvascular invasion; however, on univariate and multivariable analyses, Milan Criteria, alphafetoprotein level, multilobar involvement, and differentiation did not reach statistical significance in predicting microvascular invasion on pathology. Conclusions: In this study, potential predictors of microvascular invasion, including Milan Criteria, alphafetoprotein level, tumor differentiation, and multilobar involvement, were not predictive. Preoperative pre diction of microvascular invasion remains a challenge, suggesting the need for future studies.

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“…Treatment options for patients with HCC include locoregional ablation, surgical resection, or liver transplantation (LT). LT is the most effective treatment for HCC that arises in cirrhotic liver [4] as it eliminates both the tumor and the underlying liver disease [5].…”

Section: Introductionmentioning

confidence: 99%

Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria

et al. 2014

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Liver transplantation (LT) is the most effective treatment for hepatocellular carcinoma (HCC) that arises from cirrhosis. The Milan and the University of California, San Francisco (UCSF) selection criteria have resulted in major improvements in patient survival. We assessed our outcomes for patients with HCC that were beyond the Milan and UCSF criteria after living donor liver transplantation. We reviewed the data for 109 patients with cirrhosis and HCC who underwent living donor right lobe liver transplantation (living donor liver transplantation; LDLT) during the period from July 2004 to July 2012. Sixteen (14.7 %) patients had HCC recurrences during a mean follow-up of 35.4±26.2 months (range 4-100 months). The mean time to recurrence was 11±9.4 months (range 4-26 months). Survival rates were not significantly different between patients with HCC that met and were beyond the Milan and UCSF criteria (p=0.761 and p=0.861, respectively). The Milan and UCSF criteria were not independent risk factors for HCC recurrence or patient survival. Only poorly differentiated tumors were associated with a lower survival rate (OR=8.656, 95 % confidence interval (CI) 2.01-37.16; p= 0.004). Survival rates for patients with HCC that were beyond conventional selection criteria should encourage reconsidering the acceptable thresholds of these criteria so that more HCC patients may undergo LT without affecting outcomes.

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Recurrent hepatocellular carcinoma after liver transplant: identifying the high-risk patient

Abstract: Explant pathology can be used to predict the risk for recurrent HCC after LT, which may allow for improved adjuvant and management strategies.

Cited by 23 publications

References 12 publications

Extravascular complications following abdominal organ transplantation

Extravascular complications following abdominal organ transplantation

Untitled

Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria

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