OBJECTIVE: To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the impact of current staging criteria on long term survival. SUMMARY BACKGROUND DATA: HCC is becoming an increasingly common indication for OLT. Medicare approves OLT only for HCCs meeting the Milan criteria, thus limiting OLT for an expanding pool of potential liver recipients. We analyzed our experience with OLT for HCC to determine if expansion of criteria for OLT for HCC is warranted. METHODS: : All patients undergoing OLT for HCC from 1984 to 2006 were evaluated. Outcomes were compared for patients who met Milan criteria (single tumor < opr =5 cm, maximum of 3 total tumors with none >3 cm), University of California, San Francisco (UCSF) criteria (single tumor <6.5 cm, maximum of 3 total tumors with none >4.5 cm, and cumulative tumor size <8 cm), or exceeded UCSF criteria. RESULTS: A total of 467 transplants were performed for HCC. At mean follow up of 6.6 +/- 0.9 years, recurrence rate was 21.2%, and overall 1, 3, and 5-year survival was 82%, 65%, and 52%, respectively. Patients meeting Milan criteria had similar 5-year post-transplant survival to patients meeting UCSF criteria by preoperative imaging (79% vs. 64%; P = 0.061) and explant pathology (86% vs. 71%; P = 0.057). Survival for patients with tumors beyond UCSF criteria was significantly lower and was below 50% at 5 years. Multivariate analysis showed that tumor number (P < 0.001), lymphovascular invasion (P < 0.001), and poor differentiation (P = 0.002) independently predicted poor survival. CONCLUSIONS: This largest single institution experience with OLT for HCC demonstrates prolonged survival after liver transplantation for tumors beyond Milan criteria but within UCSF criteria, both when classified by preoperative imaging and by explant pathology. Measured expansion of OLT criteria is justified for tumors not exceeding the UCSF criteria.
OBJECTIVE: To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the impact of current staging criteria on long term survival. SUMMARY BACKGROUND DATA: HCC is becoming an increasingly common indication for OLT. Medicare approves OLT only for HCCs meeting the Milan criteria, thus limiting OLT for an expanding pool of potential liver recipients. We analyzed our experience with OLT for HCC to determine if expansion of criteria for OLT for HCC is warranted. METHODS: : All patients undergoing OLT for HCC from 1984 to 2006 were evaluated. Outcomes were compared for patients who met Milan criteria (single tumor < opr =5 cm, maximum of 3 total tumors with none >3 cm), University of California, San Francisco (UCSF) criteria (single tumor <6.5 cm, maximum of 3 total tumors with none >4.5 cm, and cumulative tumor size <8 cm), or exceeded UCSF criteria. RESULTS: A total of 467 transplants were performed for HCC. At mean follow up of 6.6 +/- 0.9 years, recurrence rate was 21.2%, and overall 1, 3, and 5-year survival was 82%, 65%, and 52%, respectively. Patients meeting Milan criteria had similar 5-year post-transplant survival to patients meeting UCSF criteria by preoperative imaging (79% vs. 64%; P = 0.061) and explant pathology (86% vs. 71%; P = 0.057). Survival for patients with tumors beyond UCSF criteria was significantly lower and was below 50% at 5 years. Multivariate analysis showed that tumor number (P < 0.001), lymphovascular invasion (P < 0.001), and poor differentiation (P = 0.002) independently predicted poor survival. CONCLUSIONS: This largest single institution experience with OLT for HCC demonstrates prolonged survival after liver transplantation for tumors beyond Milan criteria but within UCSF criteria, both when classified by preoperative imaging and by explant pathology. Measured expansion of OLT criteria is justified for tumors not exceeding the UCSF criteria.
Authors: Ronald W Busuttil; Douglas G Farmer; Hasan Yersiz; Jonathan R Hiatt; Sue V McDiarmid; Leonard I Goldstein; Sammy Saab; Steven Han; Francisco Durazo; Michael Weaver; Carlos Cao; Tony Chen; Gerald S Lipshutz; Curtis Holt; Sherilyn Gordon; Jeffery Gornbein; Farin Amersi; Rafik M Ghobrial Journal: Ann Surg Date: 2005-06 Impact factor: 12.969
Authors: J A Fernández; R Robles; C Marin; F Sánchez-Bueno; P Ramirez; J A Pons; M C Garre; D Pérez; A Parrilla; J C Navalón; P Parrilla Journal: Transplant Proc Date: 2003-08 Impact factor: 1.066
Authors: Kirti Shetty; Kate Timmins; Colleen Brensinger; Emma E Furth; Sushil Rattan; Weijing Sun; Mark Rosen; Michael Soulen; Abraham Shaked; K Rajender Reddy; Kim M Olthoff Journal: Liver Transpl Date: 2004-07 Impact factor: 5.799
Authors: Pratima Sharma; Vijayan Balan; Jose L Hernandez; Ann M Harper; Erick B Edwards; Hector Rodriguez-Luna; Thomas Byrne; Hugo E Vargas; David Mulligan; Jorge Rakela; Russell H Wiesner Journal: Liver Transpl Date: 2004-01 Impact factor: 5.799
Authors: Sasan Roayaie; Jonathan D Schwartz; Max W Sung; Sukru H Emre; Charles M Miller; Gabriel E Gondolesi; Nancy R Krieger; Myron E Schwartz Journal: Liver Transpl Date: 2004-04 Impact factor: 5.799
Authors: Victor M Zaydfudim; Neeta Vachharajani; Goran B Klintmalm; William R Jarnagin; Alan W Hemming; Maria B Majella Doyle; Keith M Cavaness; William C Chapman; David M Nagorney Journal: Ann Surg Date: 2016-10 Impact factor: 12.969
Authors: Al B Benson; Thomas A Abrams; Edgar Ben-Josef; P Mark Bloomston; Jean F Botha; Bryan M Clary; Anne Covey; Steven A Curley; Michael I D'Angelica; Rene Davila; William D Ensminger; John F Gibbs; Daniel Laheru; Mokenge P Malafa; Jorge Marrero; Steven G Meranze; Sean J Mulvihill; James O Park; James A Posey; Jasgit Sachdev; Riad Salem; Elin R Sigurdson; Constantinos Sofocleous; Jean-Nicolas Vauthey; Alan P Venook; Laura Williams Goff; Yun Yen; Andrew X Zhu Journal: J Natl Compr Canc Netw Date: 2009-04 Impact factor: 11.908
Authors: Benjamin Yip; James M Wantuck; Lily H Kim; Robert J Wong; Aijaz Ahmed; Gabriel Garcia; Mindie H Nguyen Journal: Dig Dis Sci Date: 2013-11-27 Impact factor: 3.199