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Optimal tailored screening protocol after living donor liver transplantation for hepatocellular carcinoma.

Park MS, Lee KW, Yi NJ, Choi YR, Kim H, Hong G, Suh KS, Kwon CH, Joh JW, Lee SK - J. Korean Med. Sci. (2014)

Bottom Line: Group IV showed very early recurrence within 6 months.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

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 ≥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.

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Related in: MedlinePlus

Recurrence free survival rate of 205 patients with hepatocellular carcinoma who underwent living donor liver transplantation.
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Figure 1: Recurrence free survival rate of 205 patients with hepatocellular carcinoma who underwent living donor liver transplantation.

Mentions: The 1-, 2-, and 5-yr patients' survival rates were 93%, 86%, and 75%, and grafts' survival rates were 100%, 100%, and 97%. Recurrence occurred in 55 cases (26.8%). One-year, 3-yr, and 5-yr recurrence-free survival (RFS) was 79.5%, 73.6%, and 71.8%, respectively (Fig. 1). Most recurrence occurred within 18 months. The majority of recurrences were extrahepatic: 43.6% of extrahepatic sites only, 36.4% of intrahepatic sites only and 20% of both sites. Extrahepatic sites presented most commonly in the bone (45.8%) and the lung (37.5%).


Optimal tailored screening protocol after living donor liver transplantation for hepatocellular carcinoma.

Park MS, Lee KW, Yi NJ, Choi YR, Kim H, Hong G, Suh KS, Kwon CH, Joh JW, Lee SK - J. Korean Med. Sci. (2014)

Recurrence free survival rate of 205 patients with hepatocellular carcinoma who underwent living donor liver transplantation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214935&req=5

Figure 1: Recurrence free survival rate of 205 patients with hepatocellular carcinoma who underwent living donor liver transplantation.
Mentions: The 1-, 2-, and 5-yr patients' survival rates were 93%, 86%, and 75%, and grafts' survival rates were 100%, 100%, and 97%. Recurrence occurred in 55 cases (26.8%). One-year, 3-yr, and 5-yr recurrence-free survival (RFS) was 79.5%, 73.6%, and 71.8%, respectively (Fig. 1). Most recurrence occurred within 18 months. The majority of recurrences were extrahepatic: 43.6% of extrahepatic sites only, 36.4% of intrahepatic sites only and 20% of both sites. Extrahepatic sites presented most commonly in the bone (45.8%) and the lung (37.5%).

Bottom Line: Group IV showed very early recurrence within 6 months.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

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 ≥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.

Show MeSH
Related in: MedlinePlus