Liver transplantation for hepatocellular carcinoma in clinical practice: The lesson from a 20-year multicentre experience in Italy

Fabio Farinati, Anna Giacomin, Veronica Vanin, Adriana Sergio, Patrizia Burra, Umberto Cillo, Annamaria Di Nolfo, Paolo Del Poggio, Luisa Benvegnu, Marco Zoli, Franco Borzio, Edoardo G. Giannini, Eugenio Caturelli, Nora Cazzagon, Gian Ludovico Rapaccini, Franco Trevisani

Research output: Contribution to journalArticlepeer-review

Abstract

Hepatocellular carcinoma (HCC) is an established indication for liver transplantation (LT), but the selection criteria and priority are still debated. Aims: To ascertain the number and features of patients with HCC who undergo transplantation in a Western country, the number of patients eligible for LT according to the American Association for the Study of Liver Diseases (AASLD) guidelines, the number of patients who actually undergo transplantation and whether adherence affects survival. Methods: This is a retrospective analysis from a multicentre Italian database of 2042 cases of HCC, recruited prospectively and consecutively. Kaplan-Meier (log rank) and Cox multivariate analysis estimated survival. Results: Patients who had undergone transplantation (50, 2.5%, with no change over time) had a median survival of 133 months, significantly influenced by the number of lesions and alpha-fetoprotein levels, which were found to be independent predictors of survival on multivariate analysis. Milan criteria were fulfilled in 68%, impacting on survival, whereas 48% fulfilled AASLD guidelines, without such an impact. Two hundred and twenty-eight (11%) patients were eligible for LT according to AASLD; in this group, alpha-fetoprotein levels and Child-Pugh class were independent predictors of survival. Conclusion: Among patients with HCC, those undergoing LT represent a small minority; even fewer (1%) are those who undergo transplantation according to AASLD guidelines, adherence to which only marginally affects survival. Overall, LT impact on HCC patients' treatment is very limited.

Original languageEnglish
Pages (from-to)195-202
Number of pages8
JournalEuropean Journal of Gastroenterology and Hepatology
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 2012

Keywords

  • evidence-based approach
  • guidelines
  • hepatocellular carcinoma
  • liver transplantation

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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