Pattern and management of recurrent hepatocellular carcinoma after liver transplantation

  • Enrico Regalia
  • Luigi Rainero Fassati
  • Umberto Valente
  • Andrea Pulvirenti
  • Isabella Damilano
  • Giovanni Dardano
  • Fabrizio Montalto
  • Jorgelina Coppa
  • Vincenzo Mazzaferro

DOI: 10.1007/PL00009947

Cite this article as:
Regalia, E., Fassati, L., Valente, U. et al. J Hep Bil Pancr Surg (1998) 5: 29. doi:10.1007/PL00009947

Abstract:

A series of 132 patients who underwent liver transplantation for primary liver cancer was collected from three different Italian hospitals and studied for recurrence of hepatocellular carcinoma after liver replacement. Twenty-one patients (15.9%) had a neoplastic recurrence after an average follow-up period of 7.8 months after transplantation (range, 1–25 months); 15 (71%) occurred within the first 18 months after transplant and only two recurred later than 2 years. The sites of recurrence were grafted liver (19%), lung (19%), bone (14%), and other (5%). Eight patients (38%) had multiple organ involvement at the onset. After 1, 2, 3, and 4 years the overall survival rates were 62%, 43%, 29%, and 23%, respectively. The tumor factors related to early cancer recurrence after transplantation were diameter of nodules more than 3 cm (P < 0.05), tumor stage not meeting the "Milan criteria" (P < 0.03), and presence of peri-tumoral capsule (P < 0.05); the number of nodules, TNM stage, presence of vascular invasion, alpha-fetoprotein level more than 150 UI/l, pre-transplant chemoembolization and resectability of cancer deposits did not seem to be related to early recurrence. The prognosis differed in the 7 patients with resectable recurrences (57% 4-year survival) and the 14 patients with unresectable disease (14% 4-year survival) (P < 0.02). Better patient selection and new combined medical strategies could reduce the incidence of and mortality from liver cancer recurrence after transplantation. The role of surgical resection of recurrence should be further investigated.

Key words: hepatocellular carcinoma liver transplantation immunosuppression 

Copyright information

© Springer-Verlag Tokyo 1998

Authors and Affiliations

  • Enrico Regalia
    • 1
  • Luigi Rainero Fassati
    • 2
  • Umberto Valente
    • 3
  • Andrea Pulvirenti
    • 1
  • Isabella Damilano
    • 2
  • Giovanni Dardano
    • 3
  • Fabrizio Montalto
    • 1
  • Jorgelina Coppa
    • 1
  • Vincenzo Mazzaferro
    • 1
  1. 1.Department of Surgery, Liver Transplantation Unit, National Cancer Institute, Via Venezian 1-20133, Milan, ItalyIT
  2. 2.Liver Transplantation Center — IRCCS Maggiore Hospital, University of Milan, Via Sforza 35-20100, Milan, ItalyIT
  3. 3.Department of Surgery, Liver Transplantation Unit, S. Martino Hospital, University of Genoa, V.le Benedetto XV 10-16132, Genoa, ItalyIT