Risk factors and patterns of hcc recurrence: experience after 100 liver transplantation

Purpose: Liver Transplantation (OLT) is worldwide considered the best treatment of hepatocellular carcinoma (HCC) on cirrhosis. Materials and methods: From 10/2000 to 8/2006 we performed 251 first OLT, which 100 (39.8%) for HCC on cirrhosis. Mean age were 56,2±7,2; 83/17 M/F. Causes of cirrhosis: 65 HCV, 19 HBV, 10 alcool, 3 cholestatic, 3 others. 54 patients were preoperatively treated with 37 TACE, 35 RFA, 5 PEI, 4 hepatic resections (differently associated). Initial immunosuppressive therapy was based by tacrolimus (66 pts) or cyclosporine (34 pts). Medium MELD was 17.5±10. Three neoplasia were diagnosed as hepato-cholangio carcinoma (HCC-CCC). In 20 cases HCC was incidental. Medium follow-up was 25,7±17,5 months. Results: Six patients underwent 6 re-OLT (5 PNF, 1 portal thrombosis) and 30 patients deaths (13 sepsis, 6 HCC recurrence, 4 HCV recurrence, 2 arterial hepatic thrombosis, 2 MOF, 2 IMA, 1 intraoperative death). Overall patients survival was 80% and 67% at 1 and 3 years, respectively. Thirty-five patients unfulfilled Milan criteria, mean number of lesions 2.5±2.2, mean diameter of main lesion 2.8±2.1cm, microvascular invasion 10 cases, satellitosis 15, grading G1-16, G2-55, G3-15, G4-2, Gx-12. Eleven patients developed HCC recurrence at a mean time of 9,6±5,8 months. About considered risk factors for HCC recurrence (preoperative data, demographics, indications, histological patterns, immunosuppression), predictors of recurrence at univariate analysis of disease free survival resulted Milan Criteria (p=0.002), non efficacy of preoperative treatment (p=0.02), -FP>1000 (p=0.005), mean diameter of main lesion >2 cm (p=0.024), mean diameter of total lesions >4cm (p=0.003), grading 3-4 (p=0.001), microvascular invasion (p=0.000), HCC-CCC (p=0.000), presence of necrosis (p=0.029). On multivariate analysis only microvascular invasion (p=0.000) and HCC-CCC (p=0.002) predicted HCC recurrence. Conclusions: HCC recurrence is the main cause of late mortality after liver transplantation. Microvascular invasion and the rare type of HCC-CCC are the most indipendents risk factors