INDICATIONS AND RESULTS OF LIVER-TRANSPLA NTATION IN THE TREATMENT OFHEPATOCELLULAR-CARCINOMA IN CIRRHOSIS

Liver transplantation is a treatment for hepatocellular carcinoma in c irrhosis which is both recognized, because potentially radical, and co ntroversial because associated with a high risk of recurrence. This st udy reports the results of a consecutive series of 125 patients transp lanted for hepatocellular carcinoma in cirrhosis over an 11-year perio d. Liver transplantation was indicated because of the tumour in 92 cas es (74 %) and the tumour was an incidental finding in 13 cases (10 %) or was discovered on histological examination of the hepatectomy speci men in 20 cases (16 %). The operative mortality at two months was 4 % with a 20 % morbidity, due to vascular (6 %) or biliary (14 %) complic ations. Tumour recurrence was observed in 26 patients (21 %). Recurren ce was exceptional in the incidental or histological forms of hepatoce llular carcinoma (5 %) and more frequent when the tumour constituted t he indication for transplantation (27 %). The risk of recurrence and t he survival were significantly influenced by the maximal tumour diamet er (greater than 30 mm), the number of tumour nodules (greater than 3) and the presence of portal invasion. Inclusion of these factors in pa tient selection during the second phase of the study allowed a reducti on of the risk of recurrence from 33 to 11 % and improvement of the 3- year post-transplantation survival from 53 to 76 %. Tumours less than or equal to 30 mm in diameter, with no more than 3 nodules, and withou t portal invasion are ideal indications for transplantation. Tumours w ith more than 3 nodules and larger than 30 mm appear to constitute a c ontraindication to transplantation, unless tumour reduction can be ach ieved by chemoembolization. Intermediate forms of hepatocellular carci noma between these two extreme forms are possible indications for tran splantation; depending on the availability of liver transplants.