Orthotopic Liver Transplantation for Hepatocellular Carcinoma

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Abstract
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 donortransmitted 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. Arch Surg. 1996;131:935-941

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