Optimal Tailored Screening Protocol after Living Donor Liver Transplantation for Hepatocellular Carcinoma.
10.3346/jkms.2014.29.10.1360
- Author:
Min Su PARK
1
;
Kwang Woong LEE
;
Nam Joon YI
;
Young Rok CHOI
;
Hyeyoung KIM
;
Geun HONG
;
Kyung Suk SUH
;
Choon Hyuck David KWON
;
Jae Won JOH
;
Suk Koo LEE
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. kwleegs@gmail.com
- Publication Type:Original Article
- Keywords:
Carcinoma;
Hepatocellular;
Living Donors;
Liver Transplantation;
Recurrence;
Screening
- MeSH:
Carcinoma, Hepatocellular/pathology/*surgery;
Chemoembolization, Therapeutic/adverse effects;
Disease-Free Survival;
Female;
Humans;
Liver Neoplasms/pathology/*surgery;
*Liver Transplantation;
Living Donors;
Male;
Middle Aged;
Neoplasm Recurrence, Local/*pathology;
Risk Factors;
Treatment Outcome
- From:Journal of Korean Medical Science
2014;29(10):1360-1366
- CountryRepublic of Korea
- Language:English
-
Abstract:
The indication for hepatocellular carcinoma (HCC) is expanding in living donor liver transplantation (LDLT). Early detection and effective management of recurrence has become an important issue in LDLT for HCC. This study aimed to find an optimal screening protocol in terms of screening interval and screening tools by analyzing recurrence pattern after LDLT for HCC. A total of 205 LDLT patients in two centers from February 1999 to October 2010 was reviewed. Recurrence appeared in 55 cases. Six risk factors for recurrence were identified: preoperative alpha-fetoprotein >400, Edmonson grade 3 or 4, tumor size >7 cm, tumor number > or =7, minimal tumor necrosis in the transarterial chemoembolization group and positive micro-vascular invasion. Four groups with different ranges of index scores showed different recurrence-free survival and median time to recurrence. Group I showed low and late recurrence. Groups II and III showed linearly increased rate of recurrence until 18 months. Group IV showed very early recurrence within 6 months. Across the groups, extra-hepatic recurrence developed in more than 40% of cases and multi-organ recurrence rate was 20%. The screening interval should be different based on the risk of recurrence. Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.
