Liver transplantation for hepatocellular carcinoma

Objective To analyze patient and tumor characteristics that influence patie nt survival to select patients who would most benefit from liver transplant ation. Summary Background Data The selection of patients with hepatocellular carci noma (HCC) for liver transplantation remains controversial. Methods One hundred twelve patients with nonfibrolamellar HCC who underwent a liver transplant from 1985 to 2000 were reviewed. Survival was calculate d using the Kaplan-Meier method, with differences in outcome assessed using the log-rank procedure. Multivariate analysis was then performed using a C ox regression model. Results Overall patient survival rates were 78%, 63%, and 57% at 1, 3, and 5 years, respectively. Patients infected with the hepatitis B virus had a w orse 5-year survival than those who were not (43% vs. 64%), with most death s being attributed to recurrent hepatitis B. However, patients with hepatit is B virus who underwent more recent transplants using antiviral therapy fa red as well as those who were negative for the virus, showing a 5-year surv ival rate of 77%. Patients with vascular invasion by tumor had a worse 5-ye ar survival than patients without vascular invasion (33% vs, 68%). Vascular invasion, tumor size greater than 5 cm, and poorly differentiated tumor gr ade were predictors of tumor recurrence by univariate analysis; however, on ly vascular invasion remained significant on multivariate analysis: the rat e of tumor recurrence at 5 years was 65% in patients with vascular invasion and only 4% for patients without vascular invasion. Conclusions For well-selected patients with HCC, liver transplantation in t he current era can achieve equivalent results to transplantation for nonmal ignant indications. Vascular invasion is an indicator of high risk of tumor recurrence but is difficult to detect before transplantation.