M A Zimmerman1, R M Ghobrial, M J Tong, J R Hiatt, A M Cameron, R W Busuttil. 1. Department of Surgery, Division of Liver and Pancreas Transplantation, The Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California 90095-7054, USA.
Abstract
BACKGROUND: Orthotopic liver transplantation (OLT) is a viable treatment option for patients with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However, cancer recurrence following transplantation approaches 20%. This study sought to identify the clinical and pathological factors associated with post-OLT survival. METHODS: Univariate and multivariate analyses considered the following variables: combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion, distribution, nodularity, pre- and post-OLT tumor size, pre-OLT alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race. RESULTS: Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5 years, respectively, and was significantly better in patients who were free of viral recurrence post-OLT. Similarly, patients treated with combination prophylaxis had a significantly lower mortality than those who were not. CONCLUSIONS: Multivariate analysis revealed that AFP>500 ng/mL, presence of vascular invasion by explant, HBV recurrence, and combination prophylaxis were independent predictors of HCC recurrence-free survival.
BACKGROUND: Orthotopic liver transplantation (OLT) is a viable treatment option for patients with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However, cancer recurrence following transplantation approaches 20%. This study sought to identify the clinical and pathological factors associated with post-OLT survival. METHODS: Univariate and multivariate analyses considered the following variables: combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion, distribution, nodularity, pre- and post-OLT tumor size, pre-OLT alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race. RESULTS: Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5 years, respectively, and was significantly better in patients who were free of viral recurrence post-OLT. Similarly, patients treated with combination prophylaxis had a significantly lower mortality than those who were not. CONCLUSIONS: Multivariate analysis revealed that AFP>500 ng/mL, presence of vascular invasion by explant, HBV recurrence, and combination prophylaxis were independent predictors of HCC recurrence-free survival.
Authors: Steven-Huy Han; K Rajender Reddy; Emmet B Keeffe; Consuelo Soldevila-Pico; Robert Gish; Raymond T Chung; Bulent Degertekin; Anna Lok Journal: Clin Transplant Date: 2010-11-16 Impact factor: 2.863
Authors: T F Greten; N P Malek; S Schmidt; J Arends; P Bartenstein; W Bechstein; T Bernatik; M Bitzer; A Chavan; M Dollinger; D Domagk; O Drognitz; M Düx; S Farkas; G Folprecht; P Galle; M Geißler; G Gerken; D Habermehl; T Helmberger; K Herfarth; R T Hoffmann; M Holtmann; P Huppert; T Jakobs; M Keller; J Klempnauer; F Kolligs; J Körber; H Lang; F Lehner; F Lordick; A Lubienski; M P Manns; A Mahnken; M Möhler; C Mönch; P Neuhaus; C Niederau; M Ocker; G Otto; P Pereira; G Pott; J Riemer; K Ringe; U Ritterbusch; E Rummeny; P Schirmacher; H J Schlitt; K Schlottmann; V Schmitz; A Schuler; H Schulze-Bergkamen; D von Schweinitz; D Seehofer; H Sitter; C P Straßburg; C Stroszczynski; D Strobel; A Tannapfel; J Trojan; I van Thiel; A Vogel; F Wacker; H Wedemeyer; H Wege; A Weinmann; C Wittekind; B Wörmann; C J Zech Journal: Z Gastroenterol Date: 2013-11-15 Impact factor: 2.000