LIVER-TRANSPLANTATION FOR HEPATOCELLULAR-CARCINOMA

Total hepatectomy plus liver transplantation was performed on 105 pati ents considered unsuitable for liver resection. Postoperative 5 year a ctuarial survivals correlated with the pathologic stage of the tumor: stage I 75%, stage II 68%, stage III 52.1%, and stage TVA 11%. The ove rall 5-year survival for all patients was 36%. Nodal disease, bilobar tumor, and macroscopic venous invasion were significant poor prognosis features. In addition, 12 patients with pT4N1M0 lesions (also stage I VA) had hepatectomy plus more extensive en bloc regional resection (Wh ipple procedure or cluster resection) plus transplantation in an effor t to prevent local recurrence. Only 2 of these 12 patients (16.7%) are alive and free of disease after 2 years. Seven patients (58%) have di ed from tumor recurrence usually originating from distant metastases a n average of 10.6 months after transplantation. Successful transplanta tion for hepatoma depends on screening programs to identify early stag e disease. Successful outcome of transplantation for late stage diseas e, which includes most of the patients in our series, awaits the devel opment of neoadjuvant therapy to control distant microscopic metastase s, which are almost certainly present though not apparent at the time of transplantation.