LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN CIRRHOSIS: PROGNOSTIC CRITERIA FOR BETTER PATIENT SELECTION

Abstract

Because of the shortage of liver grafts, higher recurrence and poor 5 year survival rates, most institutions practice a restrictive transplantation policy for hepatocellular carcinoma (HCC) in cirrhosis. We studied the effects of new patient selection criteria, obtained by analyzing the prognostic factors of the first group of the patients in the same series, on survival. At Paul Brousse Hospital between Nov. 1985 and Mar. 1994, 95 cirrhotic patients with preoperative histologically proven HCC underwent orthotopic liver transplantation (OLT). In the first group of patients (operated between Nov. 85 and Dec. 91), only extrahepatic metastasis was considered as a contraindication for OLT. After analyzing the prognostic criteria of the first group of patients, in the second group (operated between Dec. 91 and Mar. 94), we precised the factors primarily responsible for recidive. In conclusion, for the OLT performed for HCC in cirrhosis, the recurrence free survival was significantly better with lesions that were smaller (<30mm), less numerous (3 or less nodules) and without portal thrombosis.