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Recurrence of hepatocellular carcinoma following liver transplantation: a review of preoperative and postoperative prognostic indicators. Arch Surg 2008 Feb;143(2):182-8; discussion 188

Date

02/20/2008

Pubmed ID

18283144

DOI

10.1001/archsurg.2007.39

Scopus ID

2-s2.0-39549113180   196 Citations

Abstract

OBJECTIVE: To review the preoperative and postoperative variables that predict hepatocellular carcinoma (HCC) recurrence following orthotopic liver transplantation (OLT).

DATA SOURCES: A collective review of the literature was conducted by searching the MEDLINE database using several key words: hepatocellular carcinoma, recurrence, liver transplantation, and salvage transplantation.

STUDY SELECTION: Reviews and original articles containing basic scientific observations and long-term clinical outcomes were included.

DATA EXTRACTION: Critical observations from peer-reviewed sources were incorporated in this review.

DATA SYNTHESIS: Overall, 11 studies were reviewed to determine the incidence of HCC recurrence following OLT and to identify prognostic variables of recurrence. Four studies were evaluated to determine the efficacy of salvage transplantation following liver resection.

CONCLUSIONS: Liver transplantation is a viable treatment option for select patients with HCC and end-stage liver disease. However, in approximately 20% of patients, recurrent HCC is the rate-limiting factor for long-term survival. Despite identification of clinical parameters that may stratify patients at high risk and exhaustive preoperative staging, cancer recurrence is likely the result of microscopic extrahepatic disease. With a desperate donor organ shortage, locoregional ablation techniques and resection are being employed in patients on the waiting list to serve as a bridge to OLT. Furthermore, some have advocated aggressive surgical resection of isolated metastasis in both the liver and extrahepatic viscera. Whether these creative strategies confer a survival advantage is unknown; it will require long-term follow-up to determine their efficacy.

Author List

Zimmerman MA, Ghobrial RM, Tong MJ, Hiatt JR, Cameron AM, Hong J, Busuttil RW

Author

Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Carcinoma, Hepatocellular
Cause of Death
Female
Graft Rejection
Humans
Immunohistochemistry
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Postoperative Care
Predictive Value of Tests
Preoperative Care
Prognosis
Reoperation
Risk Assessment
Survival Analysis
Transplantation, Homologous
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0