Management experience of brain metastasis after liver transplantation for hepatocellular carcinoma
10.3760/cma.j.cn421203-20201225-00437
- VernacularTitle:肝癌肝移植术后脑转移的治疗经验
- Author:
Junjie LI
1
;
Cheng PAN
;
Yonglin DENG
;
Wentao JIANG
;
Yamin ZHANG
;
Wei GAO
;
Zhongyang SHEN
;
Hong ZHENG
Author Information
1. 天津医科大学一中心临床学院 天津市第一中心医院肝移植科，天津 300192
- Keywords:
Liver transplantation;
Hepatocellular carcinoma;
Intracranial metastatic tumor
- From:
Chinese Journal of Organ Transplantation
2022;43(1):30-33
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the pathogenesis and prognostic factors of brain metastasis of hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods:Retrospective review was performed for 17 HCC cases with brain metastasis after liver transplantation from 2000 to 2020.All cases were diagnosed as hepatitis B cirrhosis complicated with HCC.All of them were beyond the Milan Criteria.The immunosuppressive regimen consisted of baliximab + mycophenolate mofetil + calcineurin inhibitors(CNIs)+ corticosteroids in early postoperative period with a gradual tapering of corticosteroids and mycophenolate mofetil.Three patients received sirolimus immunotherapy after tumor recurrence and withdrew CNIs.One of three cases received sorafenib.Results:Other organ involvements included lung metastasis( n=16, 94.1%), bone metastasis( n=5, 29.4%)and liver metastasis( n=6, 35.3%). The median survival time after brain metastasis was 7 months and the 1-year cumulative survival rate 29.4%.The median survival time post-LT was 14 months and the 1-year cumulative survival rate 64.7%.Among 7 patients with a resection of brain metastasis, two deaths at Month 1 post-operation were due to cerebral hemorrhage.The longest survival time was 214 months and the median survival time 9 months. Conclusions:The prognosis of brain metastasis post-LT remains poor.However, early detection and reasonable treatment can prolong patient survival time and even achieve long-term survival.Most brain metastases are accompanied by lung metastases.And the finding of lung metastatic tumor hints at a presence of intracranial lesions.
