Hepatocellular carcinoma in renal transplant recipients

Renal transplant recipients display an increased risk of malignancy due to long-term immunosuppression. The type and incidence of malignancies vary geographically. Hepatocellular carcinoma (HCC) is a leading cause of malignancy in posttransplantation recipients in Taiwan, which is an endemic area for hepatitis B. We performed a retrospective study to investigate the clinical features of HCC among our renal transplant recipients.

Between 1988 and 2006, 15 patients of the 554 kidney recipients followed up at our transplantation clinic were diagnosed with HCC. The medical records corresponding to these 15 patients were reviewed for age, gender, initial presentation and symptoms, posttransplant duration, immunosuppressive regimens, graft and patient survival, treatment of HCC, and outcomes.

Fifteen recipients developed HCC, (2.7%), of whom 11 were men. Four patients were hepatitis B surface antigen (HBsAg)-positive, 4 were anti-hepatitis C antibody (anti-HCV Ab)-positive, and another 7 were negative for HBsAg and/or anti-HCV Ab. The mean age at the time of HCC diagnosis was 52 +/- 12 years, with a mean posttransplantation duration to HCC of 83 +/- 48.4 months. Over a follow-up period of 59.9 +/- 39.1 months, 8 patients remained alive and 7 died. Among these 7 individuals, 6 had no treatment for HCC and died rapidly (<3 months) and, 1 underwent hepatic lobectomy but died 6 months later due to liver failure. All 8 surviving patients received treatment: 4 underwent transarterial embolization (TAE) and the other 4 underwent surgery. As of July 2006, the average survival was 68 months. Three of these 8 patients had graft failure, including 2 whom have returned to maintenance hemodialysis and 1 who had a successful second graft.

HCC is a major cancer among renal recipients in Taiwan. In our center the outcomes of treatable patients were good. Our study revealed that either TAE or surgery resulted in excellent survival rates. It is necessary to adjust the immunosuppressive regimen in patients with HCC and to detect a malignancy at an early stage to improve the outcomes.