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1.
Bao-Gang Peng M.D. Qiang He M.D. Jia-Ping Li M.D. Fan Zhou M.D. 《American journal of surgery》2009,198(3):313-318
Purpose
To study the value of postoperative transcatheter arterial chemoembolization (TACE) to improve the efficacy of hepatectomy and tumor thrombus removal for patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT).Experimental design
From January 1996 to December 2004, 126 patients with HCC and PVTT were randomly assigned into 2 groups: a control group and a TACE group. The control group underwent liver resection combined with PVTT removal, and the TACE group underwent liver resection combined with adjuvant TACE after surgery. Survival time in the 2 groups was studied.Results
The 2 groups were comparable with regard to all clinicopathologic data. The median survival time was 13 months (95% confidence interval [CI] 6.25 to 19.75 months) for the TACE group and 9 months (95% CI 6.90 to 11.10 months) for the control group. Estimated survival rates for 1, 3 and 5 years were better in the TACE group (50.9%, 33.8%, 21.5%; respectively) than the control group (33.3%, 17.0%, 8.5%, respectively; log rank P = .0094).Conclusions
Postoperative TACE enhances the effect of liver resection combined with PVTT removal for HCC patients with PVTT. 相似文献2.
Kim JM Kwon CH Joh JW Choi MS Lee JH Koh KC Paik SW Kim GS Kim SJ Lee SK Yoo BC 《Transplantation proceedings》2012,44(2):403-408
Background
Many patients are diagnosed with hepatocellular carcinoma (HCC) within the Milan criteria. In Korea, these patients are preferentially treated with locoregional therapy (LRT) instead of living donor liver transplantation. We investigated the effectiveness of LRT in liver transplant recipients who met the Milan criteria at the time of HCC diagnosis and investigated risk factors for HCC recurrence.Methods
We retrospectively reviewed the medical records of patients diagnosed with HCC who met the Milan criteria between 2002 and 2008.Results
We performed 101 liver transplants for HCC during the study period. Seventy-one patients (70%) underwent pretransplant LRT. The disease-free survival rates at 1, 3, and 5 years in patients who received LRT were 96.6%, 93.1%, and 93.1%, and in those who did not receive LRT, 94.2%, 83.4%, and 83.4%, respectively. There were no differences between the 2 groups. Multivariate analysis showed that a low Model for End-Stage Liver Disease (MELD) score and microvascular invasion were independent predictors of HCC recurrence after transplantation. The MELD scores and rate of microvascular invasion were not statistically different in patients with or without previous LRT.Conclusion
Pretransplant LRT for patients with HCC who met the Milan criteria at the time of diagnosis did not provide a clear benefit with respect to HCC recurrence after transplantation. If patients have suitable living donors, those who meet the Milan criteria should undergo a liver transplantation as soon as possible. 相似文献3.
Swisher SG Maish M Erasmus JJ Correa AM Ajani JA Bresalier R Komaki R Macapinlac H Munden RF Putnam JB Rice D Smythe WR Vaporciyan AA Walsh GL Wu TT Roth JA 《The Annals of thoracic surgery》2004,78(4):1152-1160
Background
This study evaluates the utility of positron emission tomography (PET), endoscopic ultrasonography (EUS), and computed tomographic (CT) scans to predict pathologic response and survival following preoperative chemoradiation (CRT) in esophageal cancer.Methods
One hundred three sequential patients with locoregionally advanced esophageal cancer, who were treated with CRT and esophageal resection between May 2001 and November 2003 at the University of Texas M.D. Anderson Cancer Center, were retrospectively reviewed. PET, EUS, and CT were performed before (pre) or after (post) CRT and before surgical resection. PET standardized uptake value (SUV) was defined as maximal uptake in primary tumor.Results
Most patients were male (91 [88%]) with adenocarcinoma (90 [87%]). Pretreatment clinical stages were: IIA (42 [41%]), IIB (5 [5%]), III (50 [49%]), and IVA (6 [6%]). At the time of surgery, 58 patients (56%) had a pathologic response to CRT (≤10% viable cells). Post-CRT measurements that correlated with pathologic response were: CT esophageal wall thickness (13.3 vs 15.3 mm, p = 0.04), EUS mass size (0.7 vs 1.7 cm, p = 0.01) and PET SUV (3.1 vs 5.8, p = 0.01). Post-CRT PET SUV equal to or greater than 4 had the highest accuracy for pathologic response (76%). Univariate and multivariate Cox regression analysis demonstrated that a post-CRT PET SUV equal to or greater than 4 was an independent predictor of survival (HR, 3.5, p = 0.04).Conclusions
The FDG-PET SUV is the most accurate noninvasive test to predict long-term survival after preoperative CRT and before surgical resection. Post-CRT FDG-PET cannot, however, rule out residual microscopic disease so esophagectomy should remain a therapeutic option even if the post-CRT imaging modalities are normal. 相似文献4.
Purpose
The use of positron emission tomography (PET) with [18F] fluorodeoxyglucose (FDG) in the detection of recurrences has been well established in many tumor types. Here the authors present their experience using this modality in the evaluation of posttreatment hepatoblastoma patients.Methods
The authors conducted a retrospective review on patients with hepatoblastoma diagnosed from 1996 to 2003. FDG-PET imaging was performed together with measurement of alpha-fetal protein (AFP) during posttreatment follow-up.Results
Sixteen patients (8 boys and 8 girls) were identified in this series. The mean age was 23.5 months (range, 5 months to 4 years). Three posttreatment patients had PET results suggestive of tumor recurrence. One of these patients had normal AFP level and suspected recurrence in the caudate lobe. Radiologic-guided biopsy was performed 3 times, and there was no evidence of tumor. The other 2 patients underwent further liver resections because of mildly raised AFP levels. The histology of these showed regenerative liver tissue only with no hepatoblastoma recurrence.Conclusions
Although PET has been gaining popularity as a tool in the detection of tumor recurrences worldwide, it has been shown in this series that PET may not be useful in hepatoblastoma patients, and caution must be taken in the interpretation of positive results. 相似文献5.
Saraiva F Matos V Gonçalves L Antunes M Providência LA 《Transplantation proceedings》2011,43(5):1908-1912
Background
Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure.Methods
This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure.Results
Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases.Conclusion
EMB proved to be a suitable, safe method to monitor rejection after HT. 相似文献6.
JM Alamo C Bernal LM Marín G Suárez J Serrano L Barrera JM Sousa FJ Padillo MA Gómez-Bravo 《Transplantation proceedings》2012,44(7):2089-2092
Introduction
The reported incidences of de novo malignancy following orthotopic liver transplantation (OLT) are significantly greater than those in the general population. We have analyzed the efficacy of mammalian target of rapamycin inhibitor (mTORi) as immunosuppressant therapy in patients with de novo malignancies or those engrafted because of a primary liver cancer.Methods
We performed a case-control study of patients with hepatocellular carcinoma (HCC; n = 119), cholangiocarcinoma (n = 1) or de novo malignancies (n = 73). Thirty-seven patients with these tumors were treated with mTORi, and 167, with calcineurin inhibitors (CNI). Switching to mTORi was performed progressively, withdrawing the CNI over 15 days, until obtaining levels of 5-10 ng/dL.Results
No incidence of rejection, serious adverse events, or death was observed with an overall actuarial survival of 68.5% in the mTORi group versus 45.7% among the CNI group. Overall rates of tumor recurrence were 15.2% and 36.8%, respectively (P < .05). Among patients with HCC, survival was 100% of mTORi with and 61.5% among CNI patients, with tumor recurrence rates of 6.2% and 19.1%, respectively (P < .05).Discussion
Surprising differences in survival and tumor recurrence rates were observed among the mTORi-treated group compared with controls. Switching from CNI to mTORi immunosuppressant therapy appeared to be safe. It seems to be reasonable to employ this strategy in liver transplant patients with primary hepatic or “de novo” neoplasms. 相似文献7.
R. Raphe H.C.C. Felício M.F. Rocha W.J. Duca P.C. Arroyo Jr D. D'Santi Neto R.C.M.A. da Silva R.F. da Silva 《Transplantation proceedings》2010,42(2):505-506
Introduction
Liver transplantation for patients with hepatocellular carcinoma (HCC) is an accepted therapeutic modality, depending on the size and number of nodules. Since a high incidence of incidental HCC at transplantation has been reported, our aim was to evaluate the histopathologic characteristics of these patients.Patients and methods
This retrospective analysis from March 1998 to June 2009 included liver transplantation patients without increased alpha-fetoprotein or nodules on imaging methods. We included patients with HCC on anatomopathologic exam, excluding those presenting with HCC on the presurgery evaluation through clinical, laboratory and imaging methods.Results
Among the 277 transplanted subjects, 27 showed incidental HCC. The alpha-fetoprotein average level was 8.52 mg/dL (1.6-28.2). One patient presented with adenomatosis and focus of HCC. Histopathologic analyses showed: mean tumor size was 0.9 cm (range = 0.4-3.5); average number of tumors in each explanted liver 1.85 (range = 1-7) nodules; and three (11.1%), microvascular invasion (11.1%). The TNM staging showed 17 (63%) stage I and 6 (22%) stage II. The Edmondson and Steiner classification showed 19 (70%) subjects in degree II.Conclusion
The histopathologic presentation of incidental HCC after liver transplantation showed tumors in early stage with microvascular invasion in some cases. 相似文献8.
M. Gabrielli J. Hepp R. Pérez M. Arrese A. Soza R. Humeres J.M. Palacios E. Sanhueza G. Rencoret N. Jarufe 《Transplantation proceedings》2010,42(1):299
Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver. Liver transplantation is the best treatment for HCC; it improves survival, cures cirrhosis, and abolishes local recurrence. We describe the outcomes of patients with HCC who underwent liver transplantation in two liver transplantation centers in Chile.
Methods
This study is a clinical series elaborated from the liver transplantation database of Pontificia Universidad Católica and Clínica Alemana between 1993 and 2009. The survival of patients was calculated using the Kaplan-Meier survival analysis. The significant alpha level was defined as <.05.Results
From 250 liver transplantations performed in this period, 29 were due to HCC. At the end of the study, 25 patients (86%) were alive. The mean recurrence-free survival was 30 months (range 5 months to 8 years). The 5-year survival for patients transplanted for HCC was >80%; however, the 5-year overall survival of patients who exceeded the Milan criteria in the explants was 66%. There was no difference in overall survival between patients transplanted for HCC versus other diagnosis (P = .548).Conclusion
This series confirmed that liver transplantation is a good treatment for patients with HCC within the Milan criteria. 相似文献9.
Aim
To determine the effects of orthotopic liver transplantation in inbred rats on the mechanical properties of bones at different anatomic sites.Methods
The 24 rats that survived liver transplantation were paired with sham-operated rats of similar body weight. Six months after surgery, the lumbar vertebra, the proximal femur, and the middle femoral shaft were measured for their biomechanical properties and bone mineral density.Results
The ultimate force, the ultimate stress, the Young modulus and the bone mineral density of both the proximal femur and the middle femur shaft of the rats were significantly reduced in the liver transplant group. However, no significant change was observed in the various parameters that indicate the biomechanical properties and the bone mineral density of the lumbar vertebra.Conclusions
Orthotopic liver transplantation impairs the biomechanical properties of the proximal femur and the middle femoral shaft. Orthotopic liver transplantation itself is one of the risk factors for posttransplant fracture. 相似文献10.
E. Rubio J. González M. Jimenéz J.L. Lucena L. Gimenez F. Martinez Arrieta V. Cuervas-Mons V.S. Turrión 《Transplantation proceedings》2009,41(3):1067-1069
Background
Hepatocellular carcinoma (HCC) represents one of the most common malignancies globally, accounting for nearly one million new cases per year. Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative, a solitary metastasis from such tumors offers a possibility of cure by surgical resection. The adrenal gland is an uncommon site for metastasis from primary liver tumors.Methods
We report a liver transplantation case of HCC and hepatitis B virus in a 23-year-old man with an excellent postoperative result. However, because an increased alpha-fetoprotein was evident and complete radiologic and blood tests were performed, all of which were normal. Three years posttransplantation, a right adrenal mass was identified by CT. PAAF was performed as well as adrenalectomy for a solitary adrenal metastasis from hepatocellular carcinoma.Results
The patient underwent adrenalectomy for the right adrenal metastasis at 3 years following liver transplantation for HCC. He is presently alive and disease-free 24 months after adrenalectomy.Conclusion
Carefully selected patients with solitary metastasis from HCC may be considered for resection. 相似文献11.
S. Di Sandro A.O. Slim A. Giacomoni A. Lauterio I. Mangoni P. Aseni V. Pirotta A. Aldumour P. Mihaylov L. De Carlis 《Transplantation proceedings》2009,41(4):1283-1285
Objective
Living donor liver transplantation (LDLT) may represent a valid therapeutic option allowing several advantages for patients affected by hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). However, some reports in the literature have demonstrated worse long-term and disease-free survivals among patients treated by LDLT than deceased donor liver transplantation (DDLT) for HCC. Herein we have reported our long-term results comparing LDLT with DDLT for HCC.Patients and Methods
Among 179 patients who underwent OLT from January 2000 to December 2007, 25 (13.9%) received LDLT with HCC 154 (86.1%) received DDLT. Patients were selected based on the Milan criteria. Transarterial chemoembolization, radiofrequency ablation, percutaneous alcoholization, or liver resection was applied as a downstaging procedure while on the waiting list. Patients with stage II HCC were proposed for LDLT.Results
The overall 3- and 5-year survival rates were 77.3% and 68.7% versus 82.8% and 76.7% for LDLT and DDLT recipients, respectively, with no significant difference by the log-rank test. Moreover, the 3- and 5-year recurrence-free survival rates were 95.5% and 95.5% (LDLT) versus 90.5% and 89.4% (DDLT; P = NS).Conclusions
LDLT guarantees the same long-term results as DDLT where there are analogous selection criteria for candidates. The Milan criteria remain a valid tool to select candidates for LDLT to achieve optimal long-term results. 相似文献12.
Jason W. Smith Jonathan Moreira Gerard Abood Gerard V. Aranha Suneel Nagda Robert H. Wagner Margo Shoup 《American journal of surgery》2009,197(3):308-312
Background
The influence of positron emission tomography (PET) scanning with flourodeoxyglucose (FDG) on decision making for the treatment of patients with esophagogastric junction (EGJ) carcinoma is unclear as is the utility of the maximum standardized uptake value (SUV) as a prognostic indicator.Methods
This study was a retrospective review of EGJ carcinoma cases at a single institution during a 5-year period.Results
FDG-PET altered treatment in 13 of 64 patients (20%). Of these, 21 patients had PET scans before and after undergoing neoadjuvant chemoradiation (CRT) as well as surgery. Patients who had a decrease in SUV >50% had a 12-month disease-free survival advantage over patients a decrease in SUV <50% (93% vs 43%, P = .025).Conclusions
FDG-PET alters treatment in a significant number of patients with EGJ carcinoma. A >50% decrease in SUV after CRT is associated with an improved prognosis. 相似文献13.
Ben M. Hunt 《American journal of surgery》2009,197(5):629-1471
Background
Cancer and sarcoidosis have been associated in several small case series. This association makes the cancer patient with lymphadenopathy a diagnostic dilemma: malignant involvement of the lymph nodes is common, but benign diagnoses are possible and must be considered.Methods
We conducted a retrospective chart review of all patients with a diagnosis of sarcoidosis or mediastinal adenopathy who underwent mediastinoscopy at the Swedish Medical Center and Cancer Institute from 2004 to 2008.Results
Five hundred sixty-five mediastinoscopies were performed. There were 41 cases of biopsy-proven sarcoidosis. Twenty-one cases of sarcoidosis were diagnosed after a diagnosis of cancer. No primary cancer type was predominant. Cancers were of all stages, with and without lymph node involvement. The most common positron emission tomography combined with a computed tomography scan (PET CT) finding was bilateral hilar adenopathy with symmetric standardized uptake values (SUV) in the 4 to 15 range (62%), but many other PET CT patterns were present.Conclusions
Hypermetabolic lymphadenopathy on staging or surveillance imaging presents a diagnostic dilemma. Sarcoidosis must be considered in the differential diagnosis of patients with a history of malignancy who develop lymphadenopathy. It is imperative to obtain a tissue diagnosis before instituting therapy for presumed cancer recurrence. 相似文献14.
A Vitale P Boccagni X Kertusha G Zanus F D'Amico E Lodo D Pastorelli R Ramirez Morales G Lombardi M Senzolo P Burra U Cillo 《Transplantation proceedings》2012,44(7):1989-1991
Background
There are scarce data on the use of sorafenib for the treatment of recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT).Patients and Methods
Ten patients were treated with sorafenib after OLT following the Italian Drug Agency guidelines: they had well-compensated liver function (Child-Pugh class A in the case of cirrhosis), intermediate-or advanced-stage HCC, good general condition (performance status 0), and not suitable for loco-regional therapies. Patients with HCC recurrence after OLT were treated with sorafenib (400 mg twice daily). Adverse events (AEs) were assessed using National Cancer Institute Common Toxicity Criteria of Adverse Events (NCI-CTCAE) v3.0 with tumor responses evaluated acording to modified Response Evaluation Criteria in Select Tumors) criteria.Results
Median duration of treatment was 10 months (range, 2-18). Seven patients (70%) received an additionally targeted therapy with mTOR inhibitors as part of their immunosuppressive regimen. Most common grade 3 AEs included diarrhea (50%), hand-foot skin reaction (30%), and fatigue (20%). Sorafenib had to be discontinued in 3 patients (30%) due to AEs and 4 additional patients (40%) required a dose adjustment. No deterioration of liver graft function occurred. Three patients (30%) stopped treatment due to radiological progression of HCC, whereas 3 are still using the drug. Median time to progression was 8 months (range, 2-16). Median survival from start of therapy was 18 months (range, 4- 36).Conclusion
Our preliminary results suggest that sorafenib is a safe effective therapy for recurrent HCC after OLT. 相似文献15.
D.F. Duailibi 《Transplantation proceedings》2010,42(2):517-520
Introduction
Biliary complications are the most important source of complications after liver transplantation, and an important cause of morbidity and mortality. With the evolution of surgical transplantation techniques, including living donor and split-liver transplants, the complexity of these problems is increasing. Many studies have shown a higher incidence of biliary tract complications in living donor liver transplantation (LDLT) compared with deceased donor liver transplantation (DDLT). This article reviews biliary complications after liver transplantation and correlations with LDLT and DDLT.Objective
Provide an overview of biliary complications among LDLT and DDLT.Results
The incidence of biliary complications is higher among LDLT (28.7%) when compared with DDLT (15.5%). Bile leaks were the most common complication due to LDLT (17.1%); however, stricture was the most common complication due to DDLT (7.5%). 相似文献16.
K. Dudek O. Kornasiewicz P. Remiszewski K. Kobry&#x; B. Ziarkiewicz-Wrblewska B. Grnicka K. Zieniewicz M. Krawczyk 《Transplantation proceedings》2009,41(8):3135-3137
Introduction
Orthotopic liver transplantation (OLT) is a well-established treatment for cirrhotic patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. The aim of this study was to identify predictors of survival among 65 patients with HCC in cirrhotic livers who underwent liver transplantation (OLT).Methods
From January 2001 to December 2008, we performed 655 OLT in 615 patients. HCC was diagnosed in 58 patients before OLT and in 65 by histological examination of the explanted livers; 74% of the patients met Milan criteria by histological examination.Results
The median follow-up was 27 months (range = 1-96). We analyzed patient age and gender, etiology of liver disease, Child score at transplantation, rejection episodes, tumor number/size, vascular invasion, and differentiation grade. There was no significant difference in survival among patients grouped according to the Model for End-stage Liver Disease staging system for HCC. The 5-year survival of patients with low differentiated (G3) HCC was significantly worse than that of those with moderately differentiated (G2) or well-differentiated (G1) HCC: 50%, 81%, and 86% respectively, (P < .01). Patients with microvascular invasion displayed a worse 5-year survival than those without vascular invasion (42% vs 80%; P < .01).Conclusions
The analysis indicated that the histological grade of the tumors and evidences of microscopic vascular invasion were the most useful predictive factors for overall survival among patients with cirrhosis after liver transplantation for HCC. 相似文献17.
Yu CY Ou HY Huang TL Chen TY Tsang LL Chen CL Cheng YF 《Transplantation proceedings》2012,44(2):412-414
Background
Hepatocellular carcinoma (HCC) is the leading malignant tumor in Taiwan. The majority of HCC patients are diagnosed in late stages and therefore in eligible for potentially curative treatments. Locoregional therapy has been advocated as an effective treatment for patients with advanced HCCs.Purpose
The aim of this study was to evaluate the outcomes of HCC downstaged patients after locoregional therapy to allow eligibility for liver transplantation.Methods and materials
From January 2004 to June 2010, 161 patients with HCCs underwent liver transplantation including 51 (31.6%) who exceeded the University of California-San Francisco (UCSF) who had undergone successful locoregional therapy to be downstaged within these criteria. Among the downstaged patients, 48 (94.1%) underwent transarterial embolization; 7 (13.8%), percutaneous ethanol injection; 24 (47.1%), radiofrequency ablation; 15 (29.4%), surgical resection, and 34 (66.7%), combined treatment.Results
The overall 1- and 5-year survival rates of all HCC patients (n = 161) were 93.2% and 80.5%. The overall 1- and 5-year survival rates of downstaged (n = 51) versus non-downstaged (n = 110) subjects were 94.1% versus 83.7% and 92.7% versus 78.9%, respectively (P = .727). There are 15 (9.2%) HCC recurrences. The overall 1- and 5-year tumor-free rates of all HCC patients were 94.8% and 87.2%. The overall 1- and 5-year tumor-free rates between downstaged versus non-downstaged patients were 93.9% and 90.1% versus 95.2% and 86.0%, respectively (P = .812).Conclusion
Patients with advanced HCC exceeding the UCSF/Milan criteria can be downstaged to fit the criteria using locoregional therapy. Importantly, successfully downstaged patients who are transplanted show excellent tumor-free and overall survival rates, similar to fit-criteria group. 相似文献18.
Introduction
Although the Milan criteria are widely accepted for liver transplantation (OLT) for hepatocellular carcinoma (HCC), they have not been fully evaluated as feasible for salvage liver transplantation (SLT) of recurrent HCC after hepatic resection. The operative difficulties of SLT increase the operative risk. The aim of this study was to evaluate the feasibility of the Milan criteria for SLT and its operative complications.Patients and methods
From March 2005 to November 2007, 46 HCC patients received OLT including 15 SLTs after prior partial hepatectomy (SLT group) and 31 primary OLTs (PLT group).Results
There was no postsurgical hospital mortality among the SLT group but one case in the PLT group due to pneumonia followed by sepsis. There was no difference in the incidence of surgical complications between the two groups. Overall survival rates of SLT group patients were similar to those of the PLT group (P = .14), especially comparing both groups of patients within the Milan criteria (P = .89). There was no recurrence of HCC among the patients within the Milan criteria.Conclusions
SLT is a feasible procedure for recurrent HCC meeting the Milan criteria; the operative risk of the SLT is also acceptable. 相似文献19.
A.C. Teixeira O. Castro-e-Silva A.K. Sankarankutty F.F. Souza V. Muglia A.L.C. Martinelli 《Transplantation proceedings》2010,42(2):502-504
Introduction
Orthotopic liver transplantation (OLT) is the treatment of choice of hepatocellular carcinoma (HCC) for patients with cirrhosis, mainly those with early HCC. Herein we have present the clinical characteristics and outcomes of cirrhotic patients with HCC who underwent OLT from cadaveric donors in our institution.Methods
From May 2001 to May 2009, we performed 121 OLT including 24 patients (19.8%) with cirrhosis and HCC within the Milan criteria. In 4 cases, HCC was an incidental finding in the explants.Results
The patients' average age was 55 ± 10 years, including 82% men. Fifty percent of patients were Child class B or C. The average Model for End Stage Liver Disease for Child A, B, and C categories were 11, 15, and 18, respectively. The HCC diagnosis was made by 2 dynamic images in 16 cases; 1 dynamic image plus alphafetoprotein >400 ng/mL in 4; and 4 by histologic confirmation. Twenty patients received a locoregional treatment before OLT: 6 percutaneous ethanol injection, 9 transarterial chemoembolization, 1 transarterial embolization, and 4 a combination of these modalities. The median follow-up after OLT was 19.7 months (range, 1-51). A vascular invasion was observed in the explant of 1 patient, who developed an HCC recurrence and succumbed at 8 months after OLT. Two further patients, without vascular invasion or satellite tumor displayed tumor recurrences at 7 and 3 months after OLT, and death at 2 and 1 month after the diagnosis. The remaining 25 patients have not shown a tumor recurrence.Conclusion
In the present evaluation, OLT patients with early HCC and no vascular invasion showed satisfactory results and good disease-free survival. Strictly following the Milan criteria for liver transplantation in patients with HCC greatly reduces but does not completely avoid, the chances of tumor recurrence. 相似文献20.