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Benefit of downsizing hepatocellular carcinoma in a liver transplant population
Author(s) -
JANG J. W.,
YOU C. R.,
KIM C. W.,
BAE S. H.,
YOON S. K.,
YOO Y. K.,
KIM D. G.,
CHOI J. Y.
Publication year - 2010
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2009.04167.x
Subject(s) - medicine , hepatocellular carcinoma , milan criteria , liver transplantation , gastroenterology , population , overall survival , carcinoma , multivariate analysis , transplantation , surgery , environmental health
Aliment Pharmacol Ther 31 , 415–423 Summary Background Long‐term results after downstaging hepatocellular carcinoma (HCC) prior to liver transplantation (LT) remain unknown. Aims To investigate dropouts and post‐transplant outcome among patients with downstaged HCC by transarterial chemo‐lipiodolization (TACL). Methods Between 2000 and 2007, 386 patients with HCC initially exceeding Milan criteria underwent TACL for tumour downstaging and were consecutively enrolled. Results Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within Milan criteria. During the follow‐up, 82 eventually dropped off the waiting list for LT, with estimated dropout rates at 1, 2 and 5 years of 46.7%, 70.2%, and 87.2%, respectively. The overall post‐transplant survival rates at 1, 2 and 5 years were 89.2%, 70.3% and 54.6% and the corresponding rates for recurrence‐free survival were 74.7%, 71.8% and 66.3% respectively. Multivariate analysis indentified alpha‐fetoprotein (AFP) levels ≥100 ng/mL at LT ( P = 0.003), maximum tumour size ≥7 cm ( P = 0.002) and the lack of complete necrosis by TACL ( P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post‐transplant outcome, with an 87.5% probability of recurrence‐free survival up to 6 years. Conclusions These long‐term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Based on our data, patients with a maximum tumour size <7 cm who achieve complete necrosis together with AFP levels <100 ng/mL at LT may be the best candidates for LT following downstaging using TACL.