2019, Number 3
<< Back Next >>
Cir Cir 2019; 87 (3)
Factors associated with the survival of liver transplant patients due to hepatocellular carcinoma according to Milan criteria
Pacheco S, Rodríguez J, Briceño E, Martínez J, Guerra JF, Jarufe N
Language: Spanish
References: 25
Page: 321-327
PDF size: 259.08 Kb.
ABSTRACT
Objective: To determine the overall survival of patients undergoing liver transplantation (LT) for hepatocellular carcinoma
(HCC) following the Milan criteria (MC) and analyze factors associated with survival.
Method: Non-concurrent cohort study.
We analyzed patients undergoing LT for HCC between 2000 and 2016. An analysis of the factors associated with survival was
carried out using Kaplan-Meier, log-rank test and Cox regression. A value of p ‹ 0.05 was considered significant.
Results: A
total of 50 LT were performed for HCC. The average age was 60.8 ± 6.1 years; 38 patients (76%) were male. In the multivariate
analysis, the factors associated with survival were compliance with CM (hazard ratio [HR]: 0.104; 95% confidence interval
[95% CI]: 0.017-0.637; p = 0.01) and absence of vascular invasion (HR: 0.050; 95% CI: 0.008-0.306; p ‹ 0.01) in the explant
biopsy.
Conclusion: Survival of patients undergoing HT by HCC in our center is similar to that reported in the international
literature, and is determined by the compliance of the CM and the absence of vascular invasion in the explant biopsy.
REFERENCES
Ravaioli M, Ercolani G, Neri F, Cescon M, Stacchini G, Del Gaudio M, et al. Liver transplantation for hepatic tumors: a systematic review. World J Gastroenterol. 2014;20:5345-52.
Agopian VG, Harlander-Locke M, Zarrinpar A, Kaldas FM, Farmer DG, Yersiz H, et al. A novel prognostic nomogram accurately predicts hepatocellular carcinoma recurrence after liver transplantation: analysis of 865 consecutive liver transplant recipients. J Am Coll Surg. 2015;220:416-27.
Figueras J, Jaurrieta E, Valls C, Ramos E, Serrano T, Rafecas A, et al. Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. J Am Coll Surg. 2000;190:580-7.
Gabrielli M, Vivanco M, Hepp J, Martínez J, Pérez R, Guerra J, et al. Liver transplantation results for hepatocellular carcinoma in Chile. Transplant Proc. 2010;42:299-301.
Wan P, Zhang J, Long X, Li Q, Xu N, Zhang M, et al. Serum levels of preoperative α-fetoprotein and CA19-9 predict survival of hepatic carcinoma patients after liver transplantation. Eur J Gastroenterol Hepatol. 2014;26:553-61.
De Carlis L, Giacomoni A, Pirotta V, Lauterio A, Slim AO, Sammartino C, et al. Surgical treatment of hepatocellular cancer in the era of hepatic transplantation. J Am Coll Surg. 2003;196:887-97.
Tsuchiya K, Asahina Y, Tamaki N, Yasui Y, Hosokawa T, Ueda K, et al. Risk factors for exceeding the Milan criteria after successful radiofrequency ablation in patients with early-stage hepatocellular carcinoma. Liver Transplant. 2014;20:291-7.
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzeti F, et al. Carcinomas in patients with cirrhosis. N Engl J Med. 1996;334 693-9.
Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33:1394-403.
Roma J, Balbi E, Pacheco-Moreira L, Zyngier I, Araujo A, Agoglia L, et al. Impact of Model for End-Stage Liver Disease Score on long-term survival following liver transplantation for hepatocellular carcinoma. Transplant Proc. 2012;44:2423-7.
Sociedad Chilena de Trasplante. Guía Clínica de Trasplante Hepático. Editorial Sociedad Chilena de Trasplante. Santiago, Chile, 2009.
Clavien P, Lesurtel M, Bossuyt P. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13:1-21.
Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transplant. 2003;9:557-63.
Sourianarayanane A, El-Gazzaz G, Sanabria JR, Menon KVN, Quintini C, Hashimoto K, et al. Loco-regional therapy in patients with Milan Criteria-compliant hepatocellular carcinoma and short waitlist time to transplant: an outcome analysis. HPB (Oxford). 2012;14:325-32.
Kim JM, Kwon CHD, Joh JW, Choi MS, Lee JH, Koh KC, et al. Effectiveness of locoregional therapy before living donor liver transplantation in patients with hepatocellular carcinoma who meet the milan criteria. Transplant Proc. 2012;44:403-8.
Nissen NN, Menon V, Bresee C, Tran TT, Annamalai A, Poordad F, et al. Recurrent hepatocellular carcinoma after liver transplant: identifying the high-risk patient. HPB (Oxford). 2011;13:626-32.
Hsieh C-H, Wei C-K, Yin W-Y, Chang C-M, Tsai S-J, Wang L-Y, et al. Vascular invasion affects survival in early hepatocellular carcinoma. Mol Clin Oncol. 2015;3:252-6.
Ramanathan R, Sharma A, Lee DD, Behnke M, Bornstein K, Stravitz RT, et al. Multimodality therapy and liver transplantation for hepatocellular carcinoma: a 14-year prospective analysis of outcomes. Transplantation. 2014;98:100-6.
Choi SH, Lee HH, Lee DS, Choi JH, Heo JS, Lee KW, et al. Clinicopathological features of incidental hepatocellular carcinoma in liver transplantation. Transplant Proc. 2004;36:2293-4.
Senkerikova R, Frankova S, Sperl J, Oliverius M, Kieslichova E, Filipova H, et al. Incidental hepatocellular carcinoma: risk factors and long-term outcome after liver transplantation. Transplant Proc. 2014;46:1426-9.
Castillo E, Pelletier S, Kumer S, Abouljoud M, Divine G, Moonka D. Incidental hepatocellular carcinoma after liver transplantation: population characteristics and outcomes. Transplant Proc. 2009;41:219-21.
Shetty K, Timmins K, Brensinger C, Furth EE, Rattan S, Sun W, et al. Liver transplantation for hepatocellular carcinoma validation of present selection criteria in predicting outcome. Liver Transpl. 2011;10:911-8.
Sharr WW, Chan SC, Lo C-M. Section 3. Current status of downstaging of hepatocellular carcinoma before liver transplantation. Transplantation. 2014;97(Suppl 8):S10-7.
Ramos E, Dalmau A, Sabate A, Lama C, Llado L, Figueras J, et al. Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transplant. 2003;9:1320-7.
Boin IFSF, Leonardi MI, Luzo ACM, Cardoso AR, Caruy CA, Leonardi LS. Intraoperative massive transfusion decreases survival after liver transplantation. Transplant Proc. 2008;40:789-91.