Orthotopic liver transplantation for hepatocellular carcinoma. Factors affecting long-term patient survival

O. N. Ojogho, S. K. So, E. B. Keeffe, W. Berquist, W. Concepcion, R. Garcia-Kennedy, J. Imperial and C. O. Esquivel
Department of Surgery, Stanford University Medical Center, Calif., USA.

OBJECTIVE: To determine the influence of several clinicopathologic factors on the 3-year actuarial survival of patients with nonfibrolamellar hepatocellular carcinoma (HCC) following orthotopic liver transplantation (OLT). DESIGN: A case series of 26 consecutive patients with HCC treated with OLT, with a maximum follow-up of 90 months. SETTING: A tertiary care center. PATIENTS: Between March 1988 and December 1993, 521 OLTs were performed in 480 patients, 27 of whom had HCC. One patient was excluded because of donor-transmitted melanoma. Of the remaining 26 patients, there were 18 adults and 8 children, with a mean age of 41 years (range, 0.2-67.4 years). Fourteen patients (54%) had either hepatitis B (n = 6) or hepatitis C (n = 8), while 15 (58%) had coincidental tumor. INTERVENTION: OLT was performed using standard techniques. MAIN OUTCOME MEASURES: The effect of several clinicopathologic factors on 3-year actuarial patient survival. RESULTS: The overall actuarial survival rates for the 26 patients with HCC were 73%, 65.4%, and 65.4%, at 1, 2, and 3 years, respectively. Sixteen patients (62%) were alive at the time of this report, with 14 (54%) free of disease. None of the clinicopathologic factors significantly affected the 3-year patient survival rate. However, the rate of recurrent HCC was significantly higher in nonincidental vs coincidental tumors and in solitary vs multiple tumors. CONCLUSION: Our results suggest that HCC should not contraindicate OLT, as long-term patient survival and cure can be achieved. While patient selection is important, survival in patients with HCC after OLT is not always predictable using the usual clinicopathologic prognostic factors.