Hepatocellular carcinoma and liver transplantation: a single-center experience

Abstract

Background: Liver transplantation(LT) is thebest treatment inselectedpatients with hepatocellular carcinoma(HCC). Morphologic criteriaalone are not sufficient topredict survival. In this study,we investigated theclinical, biochemical, andpathologic factors affecting survival inpatients who under wentLT due to HCC. Methods: Between October2011 and January 2018,165 of 749 LT for HCC cases performedat the Memorial Atasehir Hospital were evaluated retrospectively. Survival, demographic characteristic sandetiology, preoperative alpha-fetoprotein(AFP) level, Model for End-StageLiver Disease (MELD) score, prognostic staging, and morphologic and histologic properties were evaluated. Results: Onehundredandthirty-nine cases of 165 were living donor liver transplantation (LDLT). Theme anage was 57.7 7.3 years, the mean follow-upperiodwas 27.8 20 months, and 41 patients(24%)died before follow-up. Recurrence of HCC was detected in 23 (14%) cases. Overall survival was 85%, 71%, and 64% for 1, 3, and 5 years, respectively. Intermsof 1-, 3-, and 5-year survival within vs beyond Milancriteria was 90%, 80%, and 76%vs 75%, 66%, and 44%, respectively. In the University of California SanFrancisco criteria, it was 86%, 76%, and70%vs 76%, 60%, and30% compared with1-, 3-, and5-year survival. While histopathological poor differentiation and AF Pelevation affected the coursenegatively. Good differentiation did not have a significant effecton survival. It was determined that poor differentiation, lymphovascular invasion, and an increased number of nodules significantly affected survival in both withinandbeyondcases. Conclusion: Atransplantdecisioniscontroversial inpatients with HCC with other than previously defined morphologic criteria. In these cases, AFP level and histologic differentiation determine survival. The results were not satisfactory in both highand/orpoorly differentiated cases.