LIVER-TRANSPLANTATION FOR THE TREATMENT OF SMALL HEPATOCELLULAR CARCINOMAS IN PATIENTS WITH CIRRHOSIS

Background. The role of orthotopic liver transplantation in the treatm ent of patients with cirrhosis and hepatocellular carcinoma is controv ersial, and determining which patients are likely to have a good outco me after liver transplantation is difficult. Methods. We studied 48 pa tients with cirrhosis who had small, unresectable hepatocellular carci nomas and who underwent liver transplantation. In 94 percent of the pa tients, the cirrhosis was related to infection with hepatitis B virus, hepatitis C virus, or both. The presence of tumor was confirmed by bi opsy or serum alpha-fetoprotein assay. The criteria for eligibility fo r transplantation were the presence of a tumor 5 cm or less in diamete r in patients with single hepatocellular carcinomas and no more than t hree tumor nodules, each 3 cm or less in diameter, in patients with mu ltiple tumors. Twenty-eight patients with sufficient hepatic function underwent treatment for the tumor, mainly chemoembolization, before tr ansplantation. After liver transplantation, the patients were followed prospectively for a median of 26 months (range, 9 to 54), No anticanc er treatment was given after transplantation. Results. The overall mor tality rate was 17 percent. After four years, the actuarial survival r ate was 75 percent and the rate of recurrence-free survival was 83 per cent. Hepatocellular carcinoma recurred in four patients (8 percent). The overall and recurrence-free survival rates at four years among the 35 patients (73 percent of the total) who met the predetermined crite ria for the selection of small hepatocellular carcinomas at pathologic al review of the explanted liver were 85 percent and 92 percent, respe ctively, whereas the rates in the 13 patients (27 percent) whose tumor s exceeded these limits were 50 percent and 59 percent, respectively ( P=0.01 for overall survival; P=0.002 for recurrence-free survival). In this group of 48 patients with early-stage tumors, tumor-node-metasta sis status, the number of tumors, the serum alphafetoprotein concentra tion, treatment received before transplantation, and 10 other variable s were not significantly correlated with survival. Conclusions. Liver transplantation is an effective treatment for small, unresectable hepa tocellular carcinomas in patients with cirrhosis.