LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN CIRRHOSIS: PROGNOSTIC CRITERIA FOR BETTER PATIENT SELECTION
HÜSEYİN ASTARCIOĞLU1, MEHMET ALİ KOÇDOR1, RENE ADAM2, HENRİ BISMUTH2, İBRAHİM ASTARCIOĞLU1
1Dokuz Eylül Üniversitesi Tıp Fakültesi, Genel Cerrahi ABD, İZMİR
2Paul Brousse Hospital, Hepatobiliary Surgery and Liver Transplantation Research Unit, Paris, FRANSA
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.
Keywords: HEPATOCELLULAR, CARCINOMA, LIVER, TRANSPLANTATION