Risk factors and patterns of HCC recurrence: Experience after 116 liver transplantation

2007 ◽  
Vol 39 (10) ◽  
pp. A40
Author(s):  
R. Montalti ◽  
G. Rompianesi ◽  
M. Masetti ◽  
L. Losi ◽  
F. Di Benedetto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Hcc Recurrence

Homocysteine: A novel prognostic biomarker in liver transplantation for alpha-fetoprotein- negative hepatocellular carcinoma

2020 ◽  
Vol 29 (2) ◽  
pp. 197-206
Author(s):  
Modan Yang ◽  
Winyen Tan ◽  
Xinyu Yang ◽  
Jianyong Zhuo ◽  
Zuyuan Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Tumor Recurrence ◽  
Prognostic Biomarker ◽  
Milan Criteria ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Independent Risk Factors ◽  
Hcc Recurrence

BACKGROUND: Precise recipient selection optimizes the prognosis of liver transplantation (LT) for hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) is the most commonly used biomarker for diagnosis and prognosis of HCC in the clinical context. As a crucial molecule in methionine cycle, homocysteine (Hcy) level has been proved to be related to HCC progression and metastasis. OBJECTIVE: We aimed to explore the prognostic capacity of pre-transplant serum Hcy level in LT for HCC. METHODS: This study retrospectively enrolled 161 HCC patients who had underwent LT from donation after cardiac death (DCD) in the First Affiliated Hospital of Zhejiang University from 2015.01.01 to 2018.09.01. Pre-transplant serum Hcy level was incorporated into statistical analysis together with other clinical parameters and pathological features. RESULTS: From an overall perspective, significant difference was observed in Hcy level between recurrence (n= 61) and non-recurrence group (n= 100) though subsequent analysis showed unsatisfactory predicting performance. In the whole cohort, multivariate analysis showed that lnAFP (p= 0.010) and Milan criteria (MC, p< 0.001) were independent risk factors of HCC recurrence after LT. MA score based on MC and lnAFP performed well in predicting post-LT tumor recurrence with the AUROC at 0.836 (p< 0.001) and 3-year recurrence-free survival rate at 96.8% (p< 0.001) in the low risk group (n= 69). According to the clinical practice, serum concentration lower than 20 μg/L is considered as normal range of AFP. Elevated pre-transplant serum AFP (> 20 μg/L) predicts high HCC recurrence after LT. We further divided the 161 recipients into AFP- group (n= 77, AFP ⩽ 20 μg/L) and AFP+ group (n= 84, AFP > 20 μg/L). MA score was still well presented in the AFP+ group and the AUROC for tumor recurrence was 0.823 (p< 0.001), whereas the predicting accuracy was reduced in AFP- group (AUROC: 0.754, P< 0.001). After subsequent analysis, we found that elevated pre-transplant Hcy level (> 12.75 μmol/L) predicted increased tumor recurrence risk in AFP- group. The 3-year recurrence-free survival rates were 92.0% and 53.7% (p< 0.001) in low Hcy subgroup (n= 40) and high Hcy subgroup (n= 37) respectively. Multivariate analysis showed that Hcy (p= 0.040) and Milan criteria (p= 0.003) were independent risk factors for post-transplant tumor recurrence in AFP- group. Further combination of Hcy level and Milan criteria identified a subgroup of AFP- recipients with acceptable outcomes even though beyond Milan criteria (3-year recurrence-free survival rate: 77.7%, p< 0.001). CONCLUSION: As a classic predictor in HCC prognosis, AFP performed well in our study cohort when combined with Milan criteria. Homocysteine was an effective prognostic biomarker in LT for AFP- hepatocellular carcinoma. In recipients exceeding Milan criteria, acceptable post-transplant outcome could be seen in those with low Hcy and AFP level.

scholarly journals Blood Transfusions and Tumor Biopsy May Increase HCC Recurrence Rates after Liver Transplantation

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Daniel Seehofer ◽  
Robert Öllinger ◽  
Timm Denecke ◽  
Moritz Schmelzle ◽  
Andreas Andreou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Multivariate Analysis ◽  
Vascular Invasion ◽  
Significant Risk ◽  
Blood Transfusions ◽  
Prognostic Impact ◽  
Tumor Biopsy ◽  
Related Risk ◽  
Hcc Recurrence

Introduction. Beneath tumor grading and vascular invasion, nontumor related risk factors for HCC recurrence after liver transplantation (LT) have been postulated. Potential factors were analyzed in a large single center experience. Material and Methods. This retrospective analysis included 336 consecutive patients transplanted for HCC. The following factors were analyzed stratified for vascular invasion: immunosuppression, rejection therapy, underlying liver disease, age, gender, blood transfusions, tumor biopsy, caval replacement, waiting time, Child Pugh status, and postoperative complications. Variables with a potential prognostic impact were included in a multivariate analysis. Results. The 5- and 10-year patient survival rates were 70 and 54%. The overall 5-year recurrence rate was 48% with vascular invasion compared to 10% without (p<0.001). Univariate analysis stratified for vascular invasion revealed age over 60, pretransplant tumor biopsy, and the application of blood transfusions as significant risk factors for tumor recurrence. Blood transfusions remained the only significant risk factor in the multivariate analysis. Recurrence occurred earlier and more frequently in correlation with the number of applied transfusions. Conclusion. Tumor related risk factors are most important and can be influenced by patient selection. However, it might be helpful to consider nontumor related risk factors, identified in the present study for further optimization of the perioperative management.

scholarly journals Risk Factors for Hepatocellular Carcinoma Recurrence and Survival after Liver Transplantation in Patients with HCV-Related Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Raphael Iglesias de Oliveira Vidal ◽  
Edison Iglesias de Oliveira Vidal ◽  
Basilio de Bragança Pereira ◽  
Cachimo Combo Assane ◽  
Alexandre Ribeiro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Overall Survival ◽  
Regression Model ◽  
Cox Regression ◽  
Microvascular Invasion ◽  
University Hospital ◽  
Explanted Liver ◽  
Hcc Recurrence

Purpose. We aimed to identify prognostic factors for survival and recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for patients with HCC and hepatitis C virus-related cirrhosis (HCV-cirrhosis). Methods. This retrospective cohort study followed all adult patients with HCV-cirrhosis who underwent LT because of HCC or had incidental HCC identified through pathologic examination of the explanted liver at a university hospital in Rio de Janeiro, Brazil, over 11 years (1998-2008). We used Cox regression models to assess the following risk factors regarding HCC recurrence or death after LT: age, Model for End-stage Liver Disease score, Child-Pugh classification, alpha-fetoprotein (AFP), whether patients had undergone locoregional treatment before transplantation, the number of packed red blood cell units (PRBCU) transfused during surgery, the number and size of HCC lesions in the explanted liver, and the presence of microvascular invasion and necrotic areas within HCC lesions. Results. Seventy-six patients were followed up for a median (interquartile range (IQR)) of 4.4 (0.7-6.6) years. Thirteen (17%) patients had HCC recurrence during the follow-up period, and 26 (34%) died. The median survival time was 6.6 years (95% CI: 2.4-12.0), and the 5-year survival was 52.5% (95% CI: 42.3-65.0%). The final regression model for overall survival included four variables: age (hazard ratio (HR): 1.02, 95% CI: 0.96-1.08, P = 0.603 ), transplantation waiting time (HR: 1.00, 95% CI: 1.00-1.00, P = 0.190 ), preoperative AFP serum levels (HR: 1.01, 95% CI: 1.00-1.02, P = 0.006 ), and whether >4 PRBCU were transfused during surgery (HR: 1.15, 95% CI: 1.05-1.25, P = 0.001 ). The final cause-specific Cox regression model for HCC recurrence included only microvascular invasion (HR: 14.86, 95% CI: 4.47-49.39, P < 0.001 ). Conclusion. In this study of LT for HCV-cirrhosis, preoperative AFP levels and the number of PRBCU transfused during surgery were associated with overall survival, whereas microvascular invasion with HCC recurrence.

scholarly journals Achieving Complete Remission of Hepatocellular Carcinoma: A Significant Predictor for Recurrence-Free Survival after Liver Transplantation

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Christin Bürger ◽  
Miriam Maschmeier ◽  
Anna Hüsing-Kabar ◽  
Christian Wilms ◽  
Michael Köhler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Complete Remission ◽  
Tumor Recurrence ◽  
Significant Risk ◽  
Treatment Modalities ◽  
Special Focus ◽  
The Impact ◽  
Hcc Recurrence

Background. Liver transplantation (LT) is a curative treatment for hepatocellular carcinoma (HCC) and the underlying primary liver disease; however, tumor recurrence is still a major issue. Therefore, the aim of this study was to assess predictors and risk factors for HCC recurrence after LT in patients within and outside the Milan criteria with a special focus on the impact of different bridging strategies. Methods. All patients who underwent LT for HCC between 07/2002 and 09/2016 at the University Hospital of Muenster were consecutively included in this retrospective study. Database research was performed and a multivariable regression analysis was conducted to explore potential risk factors for HCC recurrence. Results. A total of 82 patients were eligible for the statistical analysis. Independent of bridging strategy, achieving complete remission (CR) was significantly associated with a lower risk for tumor recurrence (p = 0.029; OR = 0.426, 95% CI 0.198-0.918). A maximal diameter of lesion < 3 cm was also associated with lower recurrence rates (p = 0.040; OR = 0.140, 95% CI 0.022-0.914). Vascular invasion proved to be an independent risk factor for HCC recurrence (p = 0.004; OR = 11.357, 95% CI 2.142-60.199). Conclusion. Achieving CR prior to LT results in a significant risk reduction of HCC recurrence after LT independent of the treatment modalities applied.

Risk factors for mortality on the liver waiting list of cirrhotic patients listed for liver transplantation

2001 ◽  
Vol 120 (5) ◽  
pp. A77-A77
Author(s):  
D DELPHINE ◽  
F AGNESE ◽  
B NADINE ◽  
L OLIVIER ◽  
L HUBERT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Waiting List ◽  
Cirrhotic Patients

Biliary cast syndrome after orthotopic liver transplantation: risk factors and outcome

2013 ◽  
Vol 51 (01) ◽  
Author(s):  
T Voigtländer ◽  
AA Negm ◽  
CP Strassburg ◽  
F Lehner ◽  
MP Manns ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Cast Syndrome

Risk factors for primary poor function in liver transplantation: a retrospective single centre analysis

2019 ◽  
Author(s):  
M Fodor ◽  
A Woerdehoff ◽  
J Walte ◽  
S Neururer ◽  
H Esser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Single Centre

Risk factors for impaired glucose tolerance and diabetes mellitus after liver transplantation

2013 ◽  
Author(s):  
Guillermo Martinez ◽  
Gonzalo Allo ◽  
Ana Fernandez ◽  
Mercedes Aramendi ◽  
Carlos Jimenez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Liver Transplantation ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance
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