Orthotopic Liver Transplantation for Hepatocellular Carcinoma: One Center's Experience in the Northeast of Brazil

• Published in: Transplantation proceedings Vol. 41; no. 5; pp. 1740 - 1742
• Main Authors: Coelho, G.R, Vasconcelos, K.F, Vasconcelos, J.B.M, Barros, M.A.P, Costa, P.E.G, Borges, G.C.O, Júnior, J.T.V, Brasil, I.R.C, Filho, D.H.C, Viana, C.F.G, Rocha, T.D.S, Mesquita, D.F, Garcia, J.H.P
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.06.2009; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Brazil; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - surgery; Carcinoma, Hepatocellular - virology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis C - complications; Humans; Liver Cirrhosis, Alcoholic - complications; Liver Neoplasms - etiology; Liver Neoplasms - surgery; Liver Neoplasms - virology; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue, organ and graft immunology; Tumors; Young Adult; South America; Brazil; America; Center; Digestive system; Liver; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Homotransplantation; Medicine; Liver cancer; Orthotopic transplantation; Experience; Treatment; Surgery; Digestive diseases; Graft; Cancer; Northeast; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.01.104

Abstract Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world and the third leading cause of cancer-related death. In this study, we sought to assess the outcome of patients with HCC who underwent orthotopic liver transplantation (OLT) in a center in the northeast of Brazil. Between May 2002 and July 2008, 294 OLTs were performed at our center. In 45 patients, HCC was confirmed by histological examination of the explant. Patients were predominantly men of ages ranging from 14–67 years. Hepatitis C virus was involved in 55.4% of the cases. Alpha fetoprotein (AFP) levels were normal in 65.2% of the patients and surpassed 100 ng/mL in only 10.4%. The median waiting time on the list was 10 months. Seventeen patients (37.7%) presented a solitary nodule, 19 (42.2%) had 2 or 3 nodules, and 9 patients (20%) had more than 3 nodules. The maximal diameter of the largest tumor was <3 cm in 26 patients (57.7%) and exceeded 5 cm in 6 patients (13.3%). Ten tumors were well differentiated, 32 were moderately differentiated, and 3 were poorly differentiated. Eleven tumors showed microvascular invasion. There have been 4 tumor recurrences. There was an association between microvascular invasion and tumor recurrence with a statistically significant relative risk. In conclusion, OLT is an excellent option for patients with HCC. The recurrence rate was low (<10%). However, we believe that more prospective studies are needed about OLT beyond the Milan criteria because our study suggested that microvascular invasion may be more important than tumor size or number.