Living related liver transplantation for hepatocellular carcinoma in Egypt

Living related liver transplantation (LRLT) for hepatocellular carcinoma (HCC) in cirrhotic patients has emerged as a rewarding therapy for a cure. Extensions of the Milan criteria have been proposed with encouraging results.

From October 2001 to June 2004, 47 adult patients with end-stage liver disease (ESLD) have been treated using LRLT, including 11 (9 males and 2 females) with HCC superimposed on hepatitis C virus (HCV)-related (n = 10) or hepatitis B virus-related (n = 1) cirrhosis. Their mean age was 50 years (range, 40-61). HCC was confirmed preoperatively in 9 subjects whereas it was an incidental finding in 2 cases. Alpha fetoprotein (AFP) levels were elevated in 5 of them. Radiologically, tumor number and sizes ranged from 1 to 2 nodules and from 1.5 to 7 cm, respectively. Five of the 11 subjects underwent pretransplantation tumor control therapy.

Nine patients are alive, all of them being disease free during follow-up periods ranging from 6 to 30 months. Two subjects died: one of HCC recurrence at 1 year posttransplantation, and another of a pulmonary embolism on day 7. AFP levels decreased to normal values in 4 cases. Excluding the 2 incidental tumors, pathological examination of the explants revealed a higher number and larger size of the nodules in 3 and 5 cases, respectively. Microvascular invasion was documented in 3 explants, 1 of which experienced HCC recurrence and the other 2 received 6 cycles of Doxorubicin following normalization of their liver profile. Postoperative complications included the following: recurrent HCC (n = 1), recurrent HCV (n = 2), acute cellular rejection (n = 3), anastomotic biliary stricture (n = 1), and subphrenic collection (n = 1).

Our current data confirm the efficacy of LRLT for treatment of HCC superimposed on liver cirrhosis.