Living donor liver transplantation in hepatocellular carcinoma: A single-center experiences

Abstract

Aim: Hepatocellular carcinoma (HCC) is the most common primary solid tumor of the liver. Hepatitis B virus (HBV) infections, Hepatitis C virus (HCV) infections and at alcoholism can be seen. The aim of this study was to evaluate living donor liver transplantation in hepatocellular carcinoma.

Methods: This is a retrospective cohort study. Between April 2014 and December 2017 at Medipol University Medical Faculty Hospital Organ Transplantation Department, 38 patients in living donor liver transplantation for HCC were evaluated.

Results: The mean patient age was 58.0 (9.9) (20–74) years; 31 (81.6%) of the 38 were male. The mean MELD score was 14.2 (8–32). Outside Milan criteria (P=0.003), poorly differentiated and cholangiocarcinoma tumor component (P=0.003) appears to be worse in living donor liver transplantation in hepatocellular carcinoma.

Conclusions: In this study, outside Milan criteria, poorly differentiated and cholangiocarcinoma tumor component appears to be worse in living donor liver transplantation in hepatocellular carcinoma. 

Keywords

• Hepatocellular carcinoma,Living donor liver transplantation

Hepatosellüler karsinomda canlı vericili karaciğer nakli: Tek merkez deneyimi

Öz

Amaç: Hepatosellür karsinom ( HCC ) karaciğerin en sık görülen primer solid tümörüdür. Hepatit B virus (HBV) enfeksiyonları, hepatit C virus ( HCV ) enfeksiyonları veya alkolizm zemininde de görülebilir. Bu çalışmanın amacı, HCC nedeniyle canlı vericili karaciğer nakli yapılan hastaların değerlendirilmesidir.

Yöntemler: Retrospektif kohort çalışma planlandı. Nisan 2014 – Aralık 2017 tarihleri arasında Medipol Üniversitesi Tıp Fakültesi, Organ Nakli Merkezi'nde HCC nedeniyle canlı vericili karaciğer nakli yapılan 38 hasta değerlendirildi. 

Bulgular: Ortalama yaş 58,0 (9,9) (20-74) yıldı; 38 kişiden 31'i (%81,6) erkekti. Ortalama MELD skoru 14,2 (8–32) idi. Milan kriterleri dışında (P=0,003), kötü farklılaşmış ve kolanjiokarsinom tümör bileşeni (P=0,003), olan hepatosellüler karsinomda canlı vericili karaciğer naklinde daha kötü görünmektedir.

Sonuçlar: Bu çalışmada Milan dışı, az differansiye ve kolanjiokarsinom komponenti olan tümörlerin daha kötü olduğu görünmektedir.

Anahtar Kelimeler

• Hepatosellüler karsinom,Canlı vericili karaciğer nakli

References

1. 1. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340:745–50.
2. 2. Molmenti EP, Marsh JW, Dvorchik I, Oliver JH 3rd, Madariaga J, Iwatsuki S. Hepatobiliary malignancies. Primary hepatic malignant neoplasms. Surg Clin North Am. 1999;79:43-57.
3. 3. Montalto G, Cervello M, Giannitrapani L, Dantona F, Terranova A, Castagnetta LA. Epidemiology, risk factors, and natural history of hepatocellular carcinoma. Ann N Y Acad Sci. 2002;963:13-20.
4. 4. Block TM, Mehta AS, Fimmel CJ, Jordan R. Molecular viral oncology of hepatocellular carcinoma. Oncogene. 2003;22:5093-107.
5. 5. Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.
6. 6. Huang J, Yan L, Cheng Z, Wu H, Du L, Wang J, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan Criteria. Ann Surg. 2010;252:903–12.
7. 7. Collier J, Sherman M. Screening for hepatocellular carcinoma. Hepatology. 1998;27:273-8.
8. 8. Simonetti RG, Gamma C, Fiorello F, Politi F, D'Amico G, Pagliaro L. Hepatocellular carcinoma. A worldwide problem and the major risk factors. Dig Dis Sci. 1991;36:862-72.

9. 9. Beasley RP. Hepatitis B virus as the etiologic agent in hepatocellular carcinoma: Epidemiologic considerations. Hepatology. 1982;2:21S.
10. 10. Kew MC. The hepatitis-B virus and hepatocellular carcinoma. Semin Liver Dis. 1981;1:59-67.
11. 11. Szmuness W. Hepatocellular carcinoma and the hepatitis B virus: Evidence for a causal association. Prog Med Virol. 1978;24:40-69.
12. 12. Larouze B, Saimot G, Lustbader ED, London WT, Werner BG, Payet M. Host responses to hepatitis-B infection in patients with primary hepatic carcinoma and their families. A case/control study in Senegal, West Africa. Lancet. 1976;2:534-8.
13. 13. Kew MC. Hepatitis C virus and hepatocellular carcinoma. FEMS Microbiol Rev. 1994;14:211-9.
14. 14. Eggel H. Uber das primare carcinom de leber. Beitr Pathol Anat. 1901;30:506-604.
15. 15. Peters RL. Pathology of hepatocellular carcinoma. In: Okuda K, Peters RL, eds. Hepatocellular Carcinoma. New York: John Wiley & Sons; 1976:107.
16. 16. Selby R, Kadry Z, Carr B, Tzakis A, Madariaga JR, Iwatsuki S. Liver transplantation for hepatocellular carcinoma. World J Surg. 1995;19:53-8.
17. 17. Goldstein RM, Baker J, Testa G. Total hepatectomy and liver transplantation for hepatocellular carcinoma. A single center experience with 72 patients. Presented at the 23rd Annual Scientific Meeting of the American Society of Transplant Surgeons, May 14-16, 1997,Chicago, IL.
18. 18. Schlitt HJ, Neipp M, Weimann A, Oldhafer KJ, Schmoll E, Boeker K, et al. Recurrence patterns of hepatocellular andfibrolamellar carcinoma after liver transplantation. J Clin Oncol. 1999;17:324-31.
19. 19. Marsh JW, Dvorchik I, Bonham CA, Iwatsuki S. Is the pathologic TNM staging system for patients with hepatoma predictive of outcome? Cancer. 2000;88:538-43.
20. 20. Molmenti EP, Klintmalm GB. Liver Transplantation in Association With Hepatocellular Carcinoma: An Update of the International Tumor Registry. Liver Transplantation. 2002;8:736-48.
21. 21. Abdelfattah M. R,Elsiesy H, Al-Manea H, Broering DC. Liver transplantation for hepatocellular carcinoma within the Milan criteria versus the University of California San Francisco criteria: a comparative study. European Journal of Gastroenterology & Hepatology. 2018, 30:398–403.
22. 22. Deprez C, Vangansbeke D, Fastrez R, Pasteels JL, Verhest A, Kiss R. Nuclear DNA content, proliferation index, and nuclear size determination in normal and cirrhotic liver, and in benignand malignant primary and metastatic hepatic tumors. Am J Clin Pathol. 1993;99:558-65.
23. 23. Ezaki T, Kanematsu T, Okamura T, Sonoda T, Sugimachi K. DNA analysis of hepatocellular carcinoma and clinicopathologic implications. Cancer. 1988;61:106-9.
24. 24. Meyer CG, Penn I, James L. Liver transplantation for cholangiocarcinoma: results in 207 patients. Transplantation. 2000;69:1633-7.
25. 25. Robles R, Figueras J, Turrión VS, Margarit C, Moya A, Varo E, et al. Spanish experience in liver transplantation for hilar and peripheral cholangiocarcinoma. Ann Surg. 2004;239:265-71.
26. 26. Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet 2014;383:2168-79.
27. 27. El-Serag HB. Epidemiology of hepatocellular carcinoma in USA. Hepatol Res. 2007;37(Suppl 2):S88–S94.
28. 28. 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;11:693–9.
29. 29. Takahashi K, Obeid J, Burmeister CS, Bruno DA, Kazimi MM, Yoshida A, et al. Intrahepatic cholangiocarcinoma in the liver explant after liver transplantation: histological differentiation and prognosis. Ann Transplant. 2016;21:208-15.
30. 30. Sapisochın G, Fernandez de Sevilla E, Charco R. Liver transplantation for cholangiocarcinoma: current status and new insights. World J Hepatol. 2015;7:2396-403.