Recurrent hepatocellular carcinoma after liver transplant: Identifying the high-risk patient
Nicholas N. Nissen, Vijay Menon, Catherine Bresee, Tram T. Tran, Alagappan Annamalai, Fred Poordad, Jeffrey H. Fair, Andrew S. Klein, Brendan Boland, Steven D Colquhoun
Background: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is rarely curable. However, in view of the advent of new treatments, it is critical that patients at high risk for recurrence are identified. Methods: Patients undergoing LT for HCC at a single centre between 2002 and 2010 were reviewed and data on clinical parameters and explant pathology were analysed to determine factors associated with HCC recurrence. All necrotic and viable tumour nodules were included in explant staging. All patients underwent LT according to the United Network for Organ Sharing (UNOS) Model for End-stage Liver Disease (MELD) tumour exception policies. Results: Liver transplantation was performed in 122 patients with HCC during this period. Rates of recurrence-free survival in the entire cohort at 1 year and 3 years were 95% and 89%, respectively. Thirteen patients developed HCC recurrence at a median of 14 months post-LT. In univariate analysis the factors associated with HCC recurrence were bilobar tumours, vascular invasion, and stage exceeding either Milan or University of California San Francisco (UCSF) Criteria. Multivariate analysis showed pathology outside UCSF Criteria was the major predictor of recurrence; when pathology outside UCSF Criteria was found in combination with vascular invasion, the predicted 3-year recurrence-free survival was only 26%. Conclusions: Explant pathology can be used to predict the risk for recurrent HCC after LT, which may allow for improved adjuvant and management strategies.
HPB
hepatocellular carcinoma
indications < transplant
liver < transplant
outcomes < transplant
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Liver Transplantation Medicine & Life Sciences
Transplants Medicine & Life Sciences
San Francisco Medicine & Life Sciences
Pathology Medicine & Life Sciences
End Stage Liver Disease Medicine & Life Sciences
Nissen, N. N., Menon, V., Bresee, C., Tran, T. T., Annamalai, A., Poordad, F., Fair, J. H., Klein, A. S., Boland, B., & Colquhoun, S. D. (2011). Recurrent hepatocellular carcinoma after liver transplant: Identifying the high-risk patient. HPB, 13(9), 626-632. https://doi.org/10.1111/j.1477-2574.2011.00342.x
Recurrent hepatocellular carcinoma after liver transplant : Identifying the high-risk patient. / Nissen, Nicholas N.; Menon, Vijay; Bresee, Catherine; Tran, Tram T.; Annamalai, Alagappan; Poordad, Fred; Fair, Jeffrey H.; Klein, Andrew S.; Boland, Brendan; Colquhoun, Steven D.
In: HPB, Vol. 13, No. 9, 01.01.2011, p. 626-632.
Nissen, NN, Menon, V, Bresee, C, Tran, TT, Annamalai, A, Poordad, F, Fair, JH, Klein, AS, Boland, B & Colquhoun, SD 2011, 'Recurrent hepatocellular carcinoma after liver transplant: Identifying the high-risk patient', HPB, vol. 13, no. 9, pp. 626-632. https://doi.org/10.1111/j.1477-2574.2011.00342.x
Nissen NN, Menon V, Bresee C, Tran TT, Annamalai A, Poordad F et al. Recurrent hepatocellular carcinoma after liver transplant: Identifying the high-risk patient. HPB. 2011 Jan 1;13(9):626-632. https://doi.org/10.1111/j.1477-2574.2011.00342.x
Nissen, Nicholas N. ; Menon, Vijay ; Bresee, Catherine ; Tran, Tram T. ; Annamalai, Alagappan ; Poordad, Fred ; Fair, Jeffrey H. ; Klein, Andrew S. ; Boland, Brendan ; Colquhoun, Steven D. / Recurrent hepatocellular carcinoma after liver transplant : Identifying the high-risk patient. In: HPB. 2011 ; Vol. 13, No. 9. pp. 626-632.
@article{169cc28957a545c28600407a6efcfe5f,
title = "Recurrent hepatocellular carcinoma after liver transplant: Identifying the high-risk patient",
abstract = "Background: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is rarely curable. However, in view of the advent of new treatments, it is critical that patients at high risk for recurrence are identified. Methods: Patients undergoing LT for HCC at a single centre between 2002 and 2010 were reviewed and data on clinical parameters and explant pathology were analysed to determine factors associated with HCC recurrence. All necrotic and viable tumour nodules were included in explant staging. All patients underwent LT according to the United Network for Organ Sharing (UNOS) Model for End-stage Liver Disease (MELD) tumour exception policies. Results: Liver transplantation was performed in 122 patients with HCC during this period. Rates of recurrence-free survival in the entire cohort at 1 year and 3 years were 95% and 89%, respectively. Thirteen patients developed HCC recurrence at a median of 14 months post-LT. In univariate analysis the factors associated with HCC recurrence were bilobar tumours, vascular invasion, and stage exceeding either Milan or University of California San Francisco (UCSF) Criteria. Multivariate analysis showed pathology outside UCSF Criteria was the major predictor of recurrence; when pathology outside UCSF Criteria was found in combination with vascular invasion, the predicted 3-year recurrence-free survival was only 26%. Conclusions: Explant pathology can be used to predict the risk for recurrent HCC after LT, which may allow for improved adjuvant and management strategies.",
keywords = "hepatocellular carcinoma, indications < transplant, liver < transplant, outcomes < transplant",
author = "Nissen, {Nicholas N.} and Vijay Menon and Catherine Bresee and Tran, {Tram T.} and Alagappan Annamalai and Fred Poordad and Fair, {Jeffrey H.} and Klein, {Andrew S.} and Brendan Boland and Colquhoun, {Steven D}",
journal = "HPB",
T1 - Recurrent hepatocellular carcinoma after liver transplant
T2 - Identifying the high-risk patient
AU - Nissen, Nicholas N.
AU - Menon, Vijay
AU - Bresee, Catherine
AU - Tran, Tram T.
AU - Annamalai, Alagappan
AU - Poordad, Fred
AU - Fair, Jeffrey H.
AU - Klein, Andrew S.
AU - Boland, Brendan
AU - Colquhoun, Steven D
N2 - Background: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is rarely curable. However, in view of the advent of new treatments, it is critical that patients at high risk for recurrence are identified. Methods: Patients undergoing LT for HCC at a single centre between 2002 and 2010 were reviewed and data on clinical parameters and explant pathology were analysed to determine factors associated with HCC recurrence. All necrotic and viable tumour nodules were included in explant staging. All patients underwent LT according to the United Network for Organ Sharing (UNOS) Model for End-stage Liver Disease (MELD) tumour exception policies. Results: Liver transplantation was performed in 122 patients with HCC during this period. Rates of recurrence-free survival in the entire cohort at 1 year and 3 years were 95% and 89%, respectively. Thirteen patients developed HCC recurrence at a median of 14 months post-LT. In univariate analysis the factors associated with HCC recurrence were bilobar tumours, vascular invasion, and stage exceeding either Milan or University of California San Francisco (UCSF) Criteria. Multivariate analysis showed pathology outside UCSF Criteria was the major predictor of recurrence; when pathology outside UCSF Criteria was found in combination with vascular invasion, the predicted 3-year recurrence-free survival was only 26%. Conclusions: Explant pathology can be used to predict the risk for recurrent HCC after LT, which may allow for improved adjuvant and management strategies.
AB - Background: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is rarely curable. However, in view of the advent of new treatments, it is critical that patients at high risk for recurrence are identified. Methods: Patients undergoing LT for HCC at a single centre between 2002 and 2010 were reviewed and data on clinical parameters and explant pathology were analysed to determine factors associated with HCC recurrence. All necrotic and viable tumour nodules were included in explant staging. All patients underwent LT according to the United Network for Organ Sharing (UNOS) Model for End-stage Liver Disease (MELD) tumour exception policies. Results: Liver transplantation was performed in 122 patients with HCC during this period. Rates of recurrence-free survival in the entire cohort at 1 year and 3 years were 95% and 89%, respectively. Thirteen patients developed HCC recurrence at a median of 14 months post-LT. In univariate analysis the factors associated with HCC recurrence were bilobar tumours, vascular invasion, and stage exceeding either Milan or University of California San Francisco (UCSF) Criteria. Multivariate analysis showed pathology outside UCSF Criteria was the major predictor of recurrence; when pathology outside UCSF Criteria was found in combination with vascular invasion, the predicted 3-year recurrence-free survival was only 26%. Conclusions: Explant pathology can be used to predict the risk for recurrent HCC after LT, which may allow for improved adjuvant and management strategies.
KW - hepatocellular carcinoma
KW - indications < transplant
KW - liver < transplant
KW - outcomes < transplant
JO - HPB
JF - HPB