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. 2019 Jun 3;8(6):787.
doi: 10.3390/jcm8060787.

Extremes of Liver Transplantation for Hepatocellular Carcinoma

Michał Grąt  1 , Maciej Krasnodębski  2 , Marek Krawczyk  3 , Jan Stypułkowski  4 , Marcin Morawski  5 , Michał Wasilewicz  6 , Zbigniew Lewandowski  7 , Karolina Grąt  8 , Waldemar Patkowski  9 , Krzysztof Zieniewicz  10
Affiliations

Extremes of Liver Transplantation for Hepatocellular Carcinoma

Michał Grąt et al. J Clin Med. .

Abstract

The aim of this retrospective observational study was to evaluate outcomes of patients with extremely advanced hepatocellular carcinoma (HCC) after liver transplantation. A total of 285 HCC patients after liver transplantation were screened for eligibility based on either intrahepatic dissemination (≥10 tumors) or macrovascular invasion. Tumor recurrence was the primary end-point. The study cohort comprised 26 patients. Median recurrence-free survival was 23.2 months with hepatitis B virus (HBV) infection (p = 0.038), higher AFP model score (p = 0.001), prolonged graft ischemia (p = 0.004), and younger donor age (p = 0.016) being significant risk factors. Median recurrence-free survival of HBV-negative and HBV-positive patients was 29.8 and 9.3 months, respectively (p = 0.053). In patients with macrovascular invasion, recurrence-free survival at 3 years was 46.3% with no specific predictors. Tumor size (p = 0.044), higher AFP model score (p = 0.019), prolonged graft ischemia (p = 0.016), and younger donor age (p = 0.041) were significant risk factors in patients with intrahepatic dissemination. Superior 3-year outcomes were observed in patients with intrahepatic dissemination and tumor size <3.5 cm (83.3%, p = 0.027) and HBV-negative patients with ischemia <9.7 h (85.7%, p = 0.028). In conclusion, patients with extremely advanced HCCs are remarkably heterogeneous with respect to their profile of tumor recurrence risk. This heterogeneity is largely driven by factors other than standard predictors of post-transplant HCC recurrence.

Keywords: alpha-fetoprotein; hepatocellular carcinoma; liver transplantation; tumor recurrence.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Recurrence-free survival of (a) all patients included in the study and (b) comparison between patients with macrovascular invasion (MVA) alone (1), hepatic dissemination alone (2), and both macrovascular invasion and intrahepatic dissemination (3). Numbers of patients at risk are presented below the graphs.
Figure 2
Figure 2
Recurrence-free survival comparisons between (a) patients without (1) and with (2) hepatitis B virus infection, (b) patients without hepatitis B virus infection and duration of graft ischemia <9.7 h (1) and ≥9.7 h (2), and (c) hepatitis B virus-negative recipients of grafts procured from donors >47 years (1) and ≤47 years (2) of age. Numbers of patients at risk are presented below the graphs.
Figure 3
Figure 3
Recurrence-free survival of patients with macrovascular invasion undergoing liver transplantation.
Figure 4
Figure 4
Recurrence-free survival of patients with intrahepatic dissemination (a) and comparisons between patients with intrahepatic dissemination and (b) tumors <3.5 cm (1) and ≥3.5 cm (2), (c) total duration of graft ischemia of <9.7 h (1) and ≥9.7 h (2), and (d) receiving grafts from donors aged >47 years (1) and ≤47 years (2). Numbers of patients at risk are presented below the graphs.
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