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Factors affecting recurrence and survival after living donor liver transplantation for hepatocellular carcinoma
Insights
Living donor liver transplantation (LDLT) offers good survival and recurrence-free rates for patients with hepatocellular carcinoma (HCC) and cirrhosis in Egypt. Alpha-fetoprotein (AFP) levels and microvascular invasion are key factors influencing outcomes.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Hepatology
Background:
- Hepatocellular carcinoma (HCC) is a major cause of cancer mortality globally, with Hepatitis C Virus (HCV) being the primary etiological factor in Egypt.
- Limited cadaveric organ availability in Egypt necessitates living donor liver transplantation (LDLT) for advanced HCC patients.
- LDLT is the sole viable liver transplantation option for HCC patients with advanced cirrhosis or unresectable tumors in Egypt.
Purpose of the Study:
- To evaluate the feasibility and outcomes of LDLT for HCC patients in Egypt.
- To identify factors influencing recurrence and survival rates post-LDLT for HCC.
- To assess the role of preoperative interventions and pathological findings in HCC recurrence after LDLT.
Main Methods:
- A retrospective analysis of 170 LDLT procedures performed between January 2004 and April 2012.
- Pathological examination of 52 HCC cases identified among LDLT recipients.
- Evaluation of patient demographics, preoperative treatments, and tumor characteristics (including AFP levels, tumor size, and microvascular invasion) for their impact on recurrence and survival.
- Follow-up included regular sonography, AFP monitoring, and CT scans with a median follow-up of 22.9 months.
Main Results:
- Hepatitis C Virus (HCV) was the predominant cause of cirrhosis (96.2%).
- Pre-transplant treatments were administered to 27.4% of patients.
- Tumor characteristics such as elevated pre-transplantation AFP (>200 ng/mL), total tumor size (>8 cm), and microvascular invasion were associated with recurrence on univariate analysis.
- Multivariate analysis identified AFP as an independent predictor of recurrence (p = 0.016).
- Both AFP levels and microvascular invasion significantly impacted survival rates (p = 0.003 for both).
Conclusions:
- LDLT is a viable and effective treatment option for patients with HCC superimposed on cirrhosis.
- Good survival and recurrence-free survival rates can be achieved with LDLT in this patient population.
- Pre-transplantation AFP levels and the presence of microvascular invasion are critical prognostic indicators for HCC recurrence and survival after LDLT.
Background/Aims:
HCC is a leading cause of cancer-related deaths worldwide. The main etiological factor in Egypt is HCV infection. Lack of cadaveric transplantation in Egypt makes LDLT the only available option for liver transplantation for HCC patients with advanced cirrhosis and/or non-resectable tumors.
Methodology:
Between January 2004 and April 2012, 170 patients underwent LDLT at the Liver Transplantation Unit, Mansoura University, and 52 (30.6%) were shown to have HCC by pathological examination. Patient demographics, preoperative interventions and pathological findings were evaluated for their influence on recurrence and survival. Patients were followed-up with abdominal sonography and AFP every 3 months and CT scans every 6 months. Median follow-up was 22.9 months.
Results:
The main cause of underlying cirrhosis was HCV (96.2%). One or more different pre-transplant treatments of HCC were performed in 14 (27.4%) patients. The median total size was 4cm (0.8-15.5). Microvascular invasion was detected in 16 (31.4%) patients; 16 patients proved to have tumors beyond the Milan criteria. Pre-transplantation AFP more than 200ng/mL, total tumor size more than 8cm and microvascular invasion influenced recurrence rate on univariate analysis. Multivariate analysis identified AFP (p = 0.016) as independent factor for recurrence. Survival was significantly affected by AFP (p = 0.003) and microvascular invasion (p = 0.003).
Conclusions:
LDLT is a feasible option for patients with HCC on top of cirrhosis with good survival and recurrence-free survival rates.
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