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Journal of Gastroenterology

, Volume 46, Issue 2, pp 249–256 | Cite as

Long-term experience with liver transplantation for hepatocellular carcinoma

  • Georgios Tsoulfas
  • Tatsuo Kawai
  • Nahel Elias
  • S. C. Ko
  • Polyxeni Agorastou
  • A. Benedict Cosimi
  • Martin Hertl
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

The effect of the model for end-stage liver disease (MELD) system on the post-transplant survival of patients with hepatocellular carcinoma (HCC) has not been fully elucidated. Our objective is to review the results of liver transplantation (LT) for HCC at the Massachusetts General Hospital over a period of 12 years, with special emphasis on the effect of the MELD system.

Methods

A retrospective review of 73 patients who underwent liver transplantation for HCC between 1995 and 2007. Outcome measures included demographics, tumor stage at explant, patient survival, and tumor recurrence.

Results

On pathologic review of the explanted liver, 12.3% of patients were classified as stage I; 42.5% as stage II, 21.9% as stage III, and 23.3% as stage IV. The overall actual survival rate was 85% at 1 year, 82% at 3 years, 73% at 5 years, and 66% at 10 years. Overall tumor recurrence was 11%. Survival rates were higher after the MELD system (5 year survival 60% before MELD vs. 85% after MELD). Recurrence decreased from 21% to 7.5%.

Conclusion

We showed improved survival for HCC after LT over the last 12 years, and especially improved survival and decreased recurrence in the time since the implementation of the MELD system.

Keywords

Liver transplantation Hepatocellular carcinoma MELD system 

Notes

Acknowledgments

No financial support or other source of funding was received by any of the authors for this project.

References

  1. 1.
    Benvegnu L, Gios M, Boccato S, Alberti A. Natural history of compensate viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut. 2004;53:744–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Sangiovanni A, Del Ninno E, Fasani P, De Fazio C, Ronchi G, Romeo R, et al. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology. 2004;126:1005–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Deuffic S, Poynard T, Buffat L, Valleron AJ. Trends in primary liver cancer. Lancet. 1998;351:214–5.CrossRefPubMedGoogle Scholar
  4. 4.
    El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340:745–50.CrossRefPubMedGoogle Scholar
  5. 5.
    Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Institute of Medicine. Analysis of waiting time. In: Committee on Organ Transplantation. Assessing current policies and the potential impact of the DHHS Final Rule. Washington, DC: National Academy Press; 1999. pp. 57–78.Google Scholar
  7. 7.
    Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Ravaioli M, Grazi GL, Ballardini G, Cavrini G, Ercolani G, Cescon M, et al. Liver transplantation with the MELD system a prospective study from a single European center. Am J Transpl. 2006;6:1572–7.CrossRefGoogle Scholar
  9. 9.
    Weismuller TJ, Negm A, Becker T, et al. The introduction of MELD-based organ allocation impacts 3-month survival after liver transplantation by influencing pretransplant patient characteristics. Transpl Int. 2009;22:970–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Kashef E, Roberts JP. Transplantation for hepatocellular carcinoma. Semin Oncol. 2001;28:497–502.CrossRefPubMedGoogle Scholar
  11. 11.
    Hemming AW, Cattral MS, Reed AI, Van der Werf WJ, Greig PD, Howard RJ. Liver transplantation for hepatocellular carcinoma. Ann Surg. 2001;233:652–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transplant. 2002;8:851–8.CrossRefGoogle Scholar
  13. 13.
    El-Serag HB. Epidemiology of hepatocellular carcinoma in USA. Hepatol Res. 2007;37:S88–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Castroguadin JF, Molina E, Bustamante M, Tome S, Otero E, Martinez J, et al. Orthotopic liver transplantation for hepatocellular carcinoma: a thirteen-year single-center experience. Transpl Proc. 2008;40:2975–7.CrossRefGoogle Scholar
  15. 15.
    Sotiropoulos GC, Druhe N, Sgourakis G, Molmenti EP, Beckebaum S, Baba HA, et al. Liver transplantation, liver resection, and transarterial chemoembolization for hepatocellular carcinoma in cirrhosis: which is the best oncological approach? Dig Dis Sci. 2009;54:2264–73.Google Scholar
  16. 16.
    Todo S, Furukawa H, Tada M. and the Japanese Liver Transplantation Study Group. Extending indication: role of living donor liver transplantation for hepatocellular carcinoma. Liver Transpl. 2007;13:S48–54.Google Scholar
  17. 17.
    Todo S, Furukawa H. On behalf of the Japanese Study Group on Organ Transplantation. Ann Surg. 2004;240:451–61.CrossRefPubMedGoogle Scholar
  18. 18.
    Rode A, Bancel B, Douek P, Chevallier M, Vilgrain V, Picaud G, et al. Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr. 2001;25:327–36.CrossRefPubMedGoogle Scholar
  19. 19.
    Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002;35:519–24.CrossRefPubMedGoogle Scholar
  20. 20.
    Burrell M, Llovet JM, Ayuso C, Iglesias C, Sala M, Miquel R, et al. Barcelona Clinic Liver Cancer Group. MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: an explant correlation. Hepatology. 2003;38:1034–42.Google Scholar
  21. 21.
    Bhartia B, Ward J, Guthrie JA, Robinson PJ. Hepatocellular carcinoma in cirrhotic livers: a double-contrast thin-section MR imaging with pathologic correlation of explanted tissue. AJR Am J Roentgenol. 2003;280:577–84.Google Scholar
  22. 22.
    Freeman RB, Mithoefer A, Ruthazer R, Nguyen K, Schore A, Harper A, et al. Optimizing staging for hepatocellular carcinoma before liver transplantation: a retrospective analysis of the UNOS/OPTN database. Liver Transpl. 2006;12:1504–11.CrossRefPubMedGoogle Scholar
  23. 23.
    Wiesner RH, Freeman RB, Mulligan DC. Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy. Gastroenterology. 2004;127:S261–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Moonka D, Castillo E, Kumer S, Abouljoud M, Divine G, Pelletier S. Impact of the model for end-stage liver disease on patient survival and disease-free survival in patients receiving liver transplantation for hepatocellular carcinoma. Transpl Proc. 2009;41:216–8.CrossRefGoogle Scholar
  25. 25.
    Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30:1434–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Llovet JM, Mas X, Aponte JJ, Fuster J, Navasa M, Christensen E, et al. Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation. Gut. 2002;50:123–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Freeman RB, Edwards EB, Harper AM. Waiting list removal rates among patients with chronic and malignant liver diseases. Am J Transplant. 2006;6:1416–21.CrossRefPubMedGoogle Scholar
  28. 28.
    Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W, et al. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl. 2003;9:557–63.CrossRefPubMedGoogle Scholar
  29. 29.
    Lu DS, Yu NC, Raman SS, Lassman C, Tong MJ, Britten C, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma as a bridge to liver transplantation. Hepatology. 2005;41:1130–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Ioannou GN, Perkins JD, Carithers RL Jr. Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival. Gastroenterology. 2008;134:1342–51.CrossRefPubMedGoogle Scholar
  31. 31.
    Freeman RB, Steffick DE, Guidinger MK, Farmer DG, Berg CL, Merion RM. Liver and intestine transplantation in the United States, 1997–2006. Am J Transplant. 2008;8:958–76.Google Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Georgios Tsoulfas
    • 1
    • 2
  • Tatsuo Kawai
    • 1
  • Nahel Elias
    • 1
  • S. C. Ko
    • 1
  • Polyxeni Agorastou
    • 1
  • A. Benedict Cosimi
    • 1
  • Martin Hertl
    • 1
  1. 1.Department of Surgery, Transplantation Unit, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.ThessaloníkiGreece

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