Twenty-year Experience with Liver Transplantation for Hepatocellular Carcinoma

Eddie R Island, James Pomposelli, Elizabeth A. Pomfret, Fredric D. Gordon, W. David Lewis, Roger L. Jenkins
Lahey Clinic, Burlington, MA

Objectives:
Liver transplantation (LT) has become the optimal treatment for stage I & II hepatocellular carcinoma (HCC). Herein we present our results of a 20 year experience, including long term followup, of LT for the treatment of HCC.
Design:
Outcomes Study
Setting:
Tertiary Care Center.
Patients: Retrospective review of prospectively collected data was preformed on a cohort of 92 patients who underwent LT for HCC between1983 and 2003.
Main Outcome Measures:
Patient demographics, tumor stage in the explant liver, patient survival and tumor recurrence data were analyzed.
Results:
The average follow up was 1052 (0-6491) days. The average tumor size was 3.6 cm, with 40% multi focal and 60% unifocal tumors. Stage I patients were 26%, while 42% were stage II, 24% were stage III, and 8% were stage IV. Overall 5-year survival was 50%, 10-year survival was 32 % and 15-year survival was 27%. Improvements in staging over the last five years has reduced the number of Stage III & IV patients from 39% to 19%, and has increased the 5 year survival to 69%. Tumor recurrence was relatively rare (13%), however recurrence resulted in a poor prognosis (75% mortality, p=0.02). The average time to recurrence was 460 days (179-1195).
Conclusions:
LT for HCC results in excellent long-term survival for Stage I &II HCC with relatively few patients dying from tumor recurrence. Improvements in preoperative staging have resulted in improved 5-year survival. Further refinements in pretransplant staging may increase the effectiveness of LT for HCC.

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