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Orthotopic liver transplantation for hepatocellular carcinoma. Factors affecting long-term patient survival
O N Ojogho1, S K So, E B Keeffe
1Department of Surgery, Stanford University Medical Center, Calif., USA.
Objective:
To determine the influence of several clinicopathologic factors on the 3-year actuarial survival of patients with nonfibrolamellar hepatocellular carcinoma (HCC) following orthotopic liver transplantation (OLT).
Design:
A case series of 26 consecutive patients with HCC treated with OLT, with a maximum follow-up of 90 months.
Setting:
A tertiary care center.
Patients:
Between March 1988 and December 1993, 521 OLTs were performed in 480 patients, 27 of whom had HCC. One patient was excluded because of donor-transmitted melanoma. Of the remaining 26 patients, there were 18 adults and 8 children, with a mean age of 41 years (range, 0.2-67.4 years). Fourteen patients (54%) had either hepatitis B (n = 6) or hepatitis C (n = 8), while 15 (58%) had coincidental tumor.
Intervention:
OLT was performed using standard techniques.
Main Outcome Measures:
The effect of several clinicopathologic factors on 3-year actuarial patient survival.
Results:
The overall actuarial survival rates for the 26 patients with HCC were 73%, 65.4%, and 65.4%, at 1, 2, and 3 years, respectively. Sixteen patients (62%) were alive at the time of this report, with 14 (54%) free of disease. None of the clinicopathologic factors significantly affected the 3-year patient survival rate. However, the rate of recurrent HCC was significantly higher in nonincidental vs coincidental tumors and in solitary vs multiple tumors.
Conclusion:
Our results suggest that HCC should not contraindicate OLT, as long-term patient survival and cure can be achieved. While patient selection is important, survival in patients with HCC after OLT is not always predictable using the usual clinicopathologic prognostic factors.