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Recipient liver function before liver transplantation influences post-transplantation survival in patients with HCC

      Highlights

      • Patients liver transplanted for HCC have a very good long-term survival.
      • The strongest survival-limiting factor after transplantation is HCC recurrence.
      • Pre-transplant liver function is an underestimated survival-determining factor.

      Abstract

      Background

      Liver transplantation (LT) is a complex yet curative treatment for a subset of patients with hepatocellular carcinoma (HCC). Due to donor organ shortage, patients with HCC need to be carefully selected for LT. In European countries, selection of patients is based on the Milan criteria, and donor organs are allocated by Eurotransplant. In order to optimize the utilization of available liver grafts, the outcome of HCC patients after LT needs to be closely monitored and evaluated.

      Methods

      We assessed the outcome of 304 HCC patients who underwent LT at a tertiary medical center over a period of nearly 20 years (February 1998 until June 2017).

      Results

      The 5-, 10- and 15-year survival rates were 62, 47 and 30%, respectively. The strongest survival-determining factor was tumour recurrence. Apart from a high tumour grading, the pre-LT MELD score was significantly and negatively associated with survival after LT.

      Conclusion

      Our results confirm the importance of recurrence for the outcome of HCC patients after LT and highlight the relevance of HCC patients' liver function before LT. Our findings encourage efforts to identify prognostically relevant factors for LT in HCC with the overall goal of refining the organ allocation system and maximizing the survival benefit after LT.

      Keywords

      Abbreviations:

      AFP (Alpha-fetoprotein), CNI (Calcineurin inhibitor), HCC (Hepatocellular carcinoma), IQR (Interquartile range), IRE (Irreversible electroporation), LT (Liver transplantation), MELD (Model for End-stage Liver Disease), MMF (Mycophenolate mofetil), mTOR-I (mTOR-inhibitor), NASH (Nonalcoholic steatohepatitis), PEI (Percutaneous ethanol injection), RFA (Radiofrequency ablation), SIRT (Selective internal radiation therapy), TACE (Transarterial chemoembolization), UNOS (United Network for Organ Sharing)
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