ORTHOTOPIC LIVER-TRANSPLANTATION FOR HEPATOCELLULAR-CARCINOMA - FACTORS AFFECTING LONG-TERM PATIENT SURVIVAL

Objective: To determine the influence of several clinicopathologic fac tors on the 3-year actuarial survival of patients with nonfibrolamella r hepatocellular carcinoma (HCC) following orthotopic liver transplant ation (OLT). Design: A case series of 26 consecutive patients with HCC created with OLT, with a maximum follow-up of 90 months. Setting: A t ertiary care center. Patients: Between March 1988 and December 1993, 5 21 OLTs were performed in 480 patients, 27 of whom had HCC. One patien t was excluded because of donor-transmitted melanoma. Of the remaining 26 patients, there were 18 adults and 8 children, with a mean age of 41 years (range, 0.2-67.4 years). Fourteen patients (54%) had either h epatitis B (n=6) or hepatitis C (n=8), while 15 (58%) had coincidental tumor. Intervention: OLT was performed using standard techniques. Mai n Outcome Measures: The effect of several clinicopathologic factors on 3-year actuarial patient survival. Results: The overall actuarial sur vival rates for the 26 patients with HCC were 73%, 65.4%, and 65.4%, a t 1, 2, and 3 years, respectively. Sixteen patients (62%) were alive a t the time of this report, with 14 (54%) free of disease. None of the clinicopathologic factors significantly affected the 3-year patient su rvival rate. However, the rate of recurrent HCC was significantly high er in nonincidental vs coincidental tumors and in solitary vs multiple tumors. Conclusion: Our results suggest that HCC should not contraind icate OLT, as long-term patient survival and cure can be achieved. Whi le patient selection is important, survival in patients with HCC after OLT is not always predictable using the usual clinicopathologic progn ostic factors.