Hepatocellular carcinoma and living donor liver transplantation; the factors associated with recurrence and survival of patients. A single center experience

Year 2013, Volume: 19 Issue: 3, 173 - 179, 01.04.2013

Yusuf Günay Necdet Güler Murat Akyıldız Murat Dayangaç Onur Yaprak Yıldıray Yüzer Yaman Tokat

Abstract

Liver transplantation is considered to be the most effective treatment for hepatocellular cancer (HCC) arising in the setting of cirrhosis. However, HCC recurrence remains a concern after liver transplantation. In this study, our goal was to investigate the factors associated with recurrence and survival of the patients after living donor liver transplantation. One hundred and nine patients underwent living donor liver transplantation due to hepatocellular cancer were included in the study. The average age was 55.2±7.82 (26-72) years and 89% of patients were male. Of the 109 patients, 57 (52.3%) met Milan criteria. The mean tumor size was 36.44±22.64 (5-140) mm and 55% of tumor had multifocality. Sixteen (14.7%) patients developed tumor recurrence in a mean follow up of 31.4±26.2 (4-94) months. Tumor size, poor differentiation and hepatitis B recurrence were associated with higher tumor recurrence and lower survival rate. Although tumors outside the Milan criteria were associated with high recurrence, they did not affect survival rate. The survival rate was lower in patients with tumor recurrence. Of the 109 patients, 87 (75.2%) were alive while 27 (24.8%) were deceased. The overall survival rates at first year in patients with recurrence and without recurrence were 54.27±12.89% and 85.54±4.36% respectively. In conclusion, tumor recurrence decreases patients survival rate after living donor liver transplantation performed for HCC. In order to predict both tumor recurrence and patient survival, all other tumor characters should be evaluated with the Milan criteria prior to transplantation.

Keywords

Living donor liver transplantation; hepatocellular carcinoma; hepatocellular carcinoma recurrence

Hepatosellüler karsinoma ve canlı vericili karaciğer nakli; kanser nüksü ve hasta sağkalımını etkileyen faktörler. Tek merkez deneyimi

Abstract

Karaciğer nakli, siroz zemininde gelişen hepatosellüler karsinomlarda en etkili tedavi yöntemi olarak kabul edilmektedir. Ancak nakil sonrası görülen tümör nüksü en kaygı verici sonuçtur. Bu çalışmamızda, canlı vericili karaciğer nakli sonrası karşılaşılan tümör nüksü ve hasta sağkalımına etki eden faktörler araştırıldı. Çalışmamıza hepatosellüler karsinom nedeni ile canlı vericili sağ lob karaciğer nakli olan 109 hasta dahil edildi. Yaş ortalaması 55.2±7.82 (26-72) yıl olan hastaların 57'si (%52.3) Milan kriterleri içinde idi. Ortalama tümör çapı 36.44±22.64 (5-140) mm olan hastalardaki tümörlerin %55'i mültifokal özellik göstermekteydi. Ortalama takip süresi olan 31.4±26.2 (4-94) ay içinde 16 (%14.7) hastada nüks tespit edildi. Tümörün çapı, kötü diferansiye tümör ve hepatit B nüksü olmasının hem tümör nüks riksini arttırdığı hem de sağkalımı düşürdüğü tespit edildi. Tümörün Milan kriterleri dışında olması nüks riskini arttırırken, sağkalım üzerinde etkisi görülmedi. Nüks gelişen hastalarda sağkalım oranı ve süresi daha düşük bulundu. Toplam 109 hastada; 87 hasta yaşarken (%75.2), 27 hastada ise (%24.8) ölüm gözlendi. Nüks gelişen ve gelişmeyen hastalardaki bir yıllık sağ kalım sıra ile %54.27±12.89 ve %85.54±4.36 olarak tespit edildi. Sonuç olarak, hepatosellüler karsinom nedeni ile yapılan karaciğer nakli sonrası gelişen nüks, sağkalım oranını azaltmaktadır. Tümörün hem nüks hem de sağkalıma olan etkisini belirlemek için, nakil öncesi Milan kriterleri ile birlikte tümörün diğer özellikleri de değerlendirilmelidir.

Keywords

Canlı vericili karaciğer nakli; hepatosellüler karsinom; hepatosellüler karsinom nüksü

References

• 1. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 1999;340(10):745-50.
• 2. Cucchetti A, Cescon M, Trevisani F, Pinna AD. Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol 2012;18(44):6398-408.
• 3. Müller V, Förtsch T, Gündel M, Croner RS, Langheinrich M, Yedibela S, et al. Long-term outcome of liver transplantation as treatment modality in patients with hepatocellular carcinoma in cirrhosis: a single-center experience. Transplant Proc 2013;45(5):1957-60.
• 4. Doyle MB, Vachharajani N, Maynard E, Shenoy S, Anderson C, Wellen JR, et al. Liver transplantation for hepatocellular carcinoma: long-term results suggest excellent outcomes. J Am Coll Surg 2012;215(1):19-28.
• 5. Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi GE, et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl 2004;10(4):534-40.
• 6. Welker MW, Bechstein WO, Zeuzem S, Trojan J. Recurrent hepatocellular carcinoma after liver transplantation; an emerging clinical challenge. Transpl Int 2013;26(2):109-18.
• 7. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334(11):693-9.
• 8. Mazzaferro V, Llovet J, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009;10(1):35-43.
• 9. Farinati F, Giacomin A, Vanin V, Sergio A, Burra P, Cillo U, et al. Liver transplantation for hepatocellular carcinoma in clinical practice: the lesson from a 20-year multicentre experience in Italy. Eur J Gastroenterol Hepatol 2012;24(2):195-202.
• 10. Hwang S, Lee SG, Joh JW, Suh KS, Kim DG. Liver transplantation for adult patients with hepatocellular carcinoma in Korea: comparison between cadaveric donor and living donor liver transplantations. Liver Transpl 2005;11(10):1265-72.
• 11. Lucey MR, Brown KA, Everson GT, Fung JJ, Gish R, Keeffe EB, et al. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg 1997;3(6):628-37.