Results of 15-Year Experience in Liver Transplant for Hepatocellular Carcinoma

Liver transplant (LT) supposes a curative option for those patients with hepatocellular carcinoma (HCC) meeting the Milan criteria. Adjuvant therapies, such as transarterial chemoembolization (TACE), can prevent tumor progression. Our aim was to analyze the outcomes of patients who have been transplanted at our center and to assess the effectiveness of TACE in patients on the waiting list for LT.

Eighty-nine patients who underwent LT for HCC at our hospital from 2002 to 2017 were included. Data on the number and size of nodules on image testing and explant, frequency of TACE and tumor response, mortality, and tumor recurrence were collected. TACE was indicated when waiting time was estimated to exceed 6 months in patients with well-preserved liver function (Child-Pugh score A-B7). Magnetic resonance imaging (MRI) was performed after TACE.

We found a single nodule in 64% of patients and multiple nodules in 36% of patients. Mean size of nodule on image testing was 38.29 mm, similar to the mean size at explant (32.65 mm). TACE was performed in 66 patients (74.2%). Ten patients did not meet the Milan criteria at explant, 6 of whom died, and 10 patients had tumor recurrence at mean of 22.6 months. Overall mortality was 44.9%, but only 10 patients died because of tumor recurrence.

TACE responses were achieved in one third of patients and there was an 11.2% recurrence rate for HCC. Mortality in our experience has been related to exceeding the Milan criteria at explant.