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A Review of Preoperative and Postoperative Prognostic Indicators

Michael A. Zimmerman, MD; R. Mark Ghobrial, MD, PhD; Myron J. Tong, MD, PhD; Jonathan R. Hiatt, MD; Andrew M. Cameron, MD, PhD; Johnny Hong, MD; Ronald W. Busuttil, MD, PhD

Arch Surg. 2008;143(2):182-188.

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 Affiliations: Department of Surgery, Division of Liver and Pancreas Transplantation, the Pfleger Liver Institute, the Dumont–University of California, Los Angeles, Transplant Center, the David Geffen School of Medicine, University of California, Los Angeles.

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