THE ROLE OF TRANSPLANTATION IN SMALL HEPATOCELLULAR-CARCINOMA COMPLICATING CIRRHOSIS OF THE LIVER

Of 176 hepatic transplants performed from 1986 to December 1992, 27 pa tients had small hepatocellular carcinoma (less than or equal to 5 cen timeters) complicating cirrhosis of the liver. Ah patients were asympt omatic for the hepatic malignancy and the diagnosis was established in each instance preoperatively by means of serial sonographic scans and alpha-fetoprotein levels. Cirrhosis was classified as Child's A in ei ght instances, as Child's B in 16 and Child C's in three. The cause wa s alcoholic in three patients, posthepatitic in 21 patients (eight hep atitis B virus [HBV] positive and 13 hepatitis C virus [HCV] positive) and undetermined in three. The in-hospital mortality rate was 11 perc ent (three of 27). Additionally, five patients died at different inter vals after transplantation: only two died of neoplastic recurrence at 12 and 32 months, respectively (7.4 percent rate). Actuarial survival rates were 82 percent at one year and 71 percent at three years, with a mean followup period of 32 months (range six to 78 months). Morbidit y related to the procedure was a relevant problem: 21 percent of the p atients had prompt resumption of normal life while 37 percent required repeated hospitalization and 42 percent required strict control on an outpatient basis. The most frequent problem was HBV or HCN reinfectio n of the grafted liver, which occurred in 42 percent. Based on this ex perience, transplantation of the liver has shown an excellent oncologi c accuracy for small hepatocellular carcinoma in cirrhosis of the live r, thus representing the most rational surgical procedure for patients with Child's B and Child's C cirrhosis classification. The relevant m ortality and morbidity rates, strictly related to this procedure, sugg est other options as more appropriate in those with Child A cirrhosis at this time.