Prognostic impact of incidentally detected hepatocellular carcinoma in explanted livers after living donor liver transplantation.
Carcinoma, Hepatocellular
/ diagnosis
Female
Humans
Incidental Findings
Liver
/ pathology
Liver Neoplasms
/ diagnosis
Liver Transplantation
/ adverse effects
Living Donors
Male
Middle Aged
Neoplasm Recurrence, Local
/ mortality
Postoperative Complications
/ diagnosis
Prognosis
Prospective Studies
Retrospective Studies
Risk Factors
Survival Rate
Transplants
/ pathology
Chronic liver disease
Cirrhosis
Hepatocellular carcinoma
Liver cancer
Liver transplantation
Malignancy
Non-alcoholic steatohepatitis
Prognosis
Recurrence
Survival
Viral hepatitis
Journal
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
ISSN: 0975-0711
Titre abrégé: Indian J Gastroenterol
Pays: India
ID NLM: 8409436
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
31
03
2020
accepted:
17
11
2020
pubmed:
7
2
2021
medline:
16
11
2021
entrez:
6
2
2021
Statut:
ppublish
Résumé
The impact of incidentally detected hepatocellular carcinoma (iHCC) in explanted liver on the prognosis of the patients undergoing orthotopic liver transplantation remains controversial with several studies reporting survival worse than true non-hepatocellular carcinoma (non-HCC) recipients. Patients undergoing living donor liver transplantation (LDLT) have the benefit of a shorter waiting time to transplant which in principle should reduce the frequency of new tumors developing while waiting for transplant. We aimed to evaluate the incidence, histopathological features, and impact of iHCC on short- and long-term outcomes in adult LDLT recipients. The present study retrospectively analyzed the patients' demographics, tumor characteristics, and outcomes of iHCC in adult patients undergoing LDLT for non-HCC indications at our center between August 2009 and March 2018. Five hundred and forty-five adults underwent LDLT in our center during the study period. iHCC was detected in the explanted livers in 28 patients (5.1%) out of 545 LDLTs. Only one patient had iHCC beyond Milan criteria. No tumor recurrence was observed in the iHCC cohort after a median follow-up of 28 months. Five-year overall and recurrence-free survival was 96.4%. Incidence of iHCC in explanted livers after LDLT is low and most patients have very early-stage tumors with excellent recurrence-free survival. Hence, no specific post-transplant surveillance or treatment is necessary.
Sections du résumé
BACKGROUND
The impact of incidentally detected hepatocellular carcinoma (iHCC) in explanted liver on the prognosis of the patients undergoing orthotopic liver transplantation remains controversial with several studies reporting survival worse than true non-hepatocellular carcinoma (non-HCC) recipients. Patients undergoing living donor liver transplantation (LDLT) have the benefit of a shorter waiting time to transplant which in principle should reduce the frequency of new tumors developing while waiting for transplant. We aimed to evaluate the incidence, histopathological features, and impact of iHCC on short- and long-term outcomes in adult LDLT recipients.
METHODS
The present study retrospectively analyzed the patients' demographics, tumor characteristics, and outcomes of iHCC in adult patients undergoing LDLT for non-HCC indications at our center between August 2009 and March 2018.
RESULTS
Five hundred and forty-five adults underwent LDLT in our center during the study period. iHCC was detected in the explanted livers in 28 patients (5.1%) out of 545 LDLTs. Only one patient had iHCC beyond Milan criteria. No tumor recurrence was observed in the iHCC cohort after a median follow-up of 28 months. Five-year overall and recurrence-free survival was 96.4%.
CONCLUSIONS
Incidence of iHCC in explanted livers after LDLT is low and most patients have very early-stage tumors with excellent recurrence-free survival. Hence, no specific post-transplant surveillance or treatment is necessary.
Identifiants
pubmed: 33548018
doi: 10.1007/s12664-020-01127-7
pii: 10.1007/s12664-020-01127-7
doi:
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
30-34Références
Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012;57:675–88.
Taniguchi M. Liver transplantation in the MELD era – analysis of the OPTN/UNOS registry. Clin Transpl. 2012;41–65.
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.
Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective exploratory analysis. Lancet Oncol. 2009;10:35–43.
Sotiropoulos GC, Malago M, Molmenti EP, et al. Liver transplantation and incidentally found hepatocellular carcinoma in liver explants: need for a new definition? Transplantation. 2006;81:531–5.
doi: 10.1097/01.tp.0000198739.42548.3e
Caroli-Bottino A, Nascimento CM, Basto S, et al. Hepatocellular carcinoma: incidental finding in cirrhotic explanted livers. Transplant Proc. 2005;37:2791–2.
Chui AK, Wong J, Rao AR, et al. High incidence of incidental hepatocellular carcinoma exists among hepatitis explanted livers. Transplant Proc. 2003;35:350–1.
doi: 10.1016/S0041-1345(02)04010-1
Kishi Y, Sugawara Y, Tamura S, Kaneko J, Kokudo N, Makuuchi M. Impact of incidentally found hepatocellular carcinoma on the outcome of living donor liver transplantation. Transpl Int. 2006;19:720–5.
doi: 10.1111/j.1432-2277.2006.00338.x
Senkerikova R, Frankova S, Speri J, et al. Incidental hepatocellular carcinoma: risk factors and long-term outcome after liver transplantation. Transplant Proc. 2014;46:1426–9.
doi: 10.1016/j.transproceed.2014.03.010
El Moghazy W, Kashkoush S, Meeberg G, Kneteman N. Incidence, characteristics and prognosis of incidentally discovered hepatocellular carcinoma after liver transplantation. J Transp Secur. 2016;2016:1916387.
Perez P, Rodriguez-Peralvarez M, Guerrero L, et al. Incidental hepatocellular carcinoma after liver transplantation: prevalence, histopathological features and prognostic impact. PLoS One. 2017;12:e0175010.
Abdelfattah MR, Abblkhail F, Al-Manea H. Misdiagnosed or incidentally detected hepatocellular carcinoma in explanted livers: lessons learned. Ann Transplant. 2015;20:366–72.
doi: 10.12659/AOT.893782
Rizzi PM, Kane PA, Ryder SD, et al. Accuracy of radiology in detection of hepatocellular carcinoma before liver transplantation. Gastroenterology. 1994;107:1425–9.
Bialecki ES, Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005;7:26–34.
doi: 10.1080/13651820410024049
Kierans AS, Kang SK, Rosenkrantz AB. The diagnostic performance of dynamic contrast-enhanced MR imaging for detection of small hepatocellular carcinoma measuring up to 2 cm: a meta-analysis. Radiology. 2016;278:82–94.
doi: 10.1148/radiol.2015150177
Klintmalm GB. Liver transplantation for hepatocellular carcinoma: a registry report of the impact of tumor characteristics outcome. Ann Surg. 1998;228:479–90.
doi: 10.1097/00000658-199810000-00005
Castillo E, Pelletier S, Kumer S, Abouljoud M, Divine G, Moonka D. Incidental hepatocellular carcinoma after liver transplantation: population characteristics and outcomes. Transplant Proc. 2009;41:219–21.
doi: 10.1016/j.transproceed.2008.10.053
Mourad MM, Algarni A, Aly MA, et al. Tumor characteristics and long-term outcome of incidental hepatocellular carcinoma after orthotopic liver transplant. Exp Clin Transplant. 2015;13:333–8.