Liver transplantation for hepatocellular carcinoma: The impact of human immunodeficiency virus infection—21 plus 13

✍ Scribed by Umberto Baccarani; Gian Luigi Adani; Marcello Tavio; Pierluigi Viale

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 352 KB
• Volume: 53
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.24287

✦ Synopsis

We read with interest the article by Vibert et al. 1 recently published in HEPATOLOGY. The authors described their single-center experience with liver transplantation for hepatocellular carcinoma (HCC) in human immunodeficiency virus (HIV)-positive patients (21 cases) and compared those patients to HIV-negative patients (61 cases) who were also affected by HCC. Because of the higher dropout rate among the HIV-positive patients (23.8% versus 11.4%), HIV infection impaired the results of liver transplantation for HCC on an intent-to-treat basis but had no significant impact on overall survival and recurrence-free survival after liver transplantation. In our center from 2005 to 2010, we performed transplantation for 13 HIV-positive patients affected by HCC. The characteristics of this cohort are reported in Table 1. Unlike Vibert et al.'s patients, none of our patients were dropped from the waiting list. None experienced HCC recurrence, although three patients were outside the Milan criteria at listing (23%); only one of those patients (7.7%) had microvascular invasion. Seventy-seven percent had grade 2 and 23% had grade 3 HCC according to Edmondson-Steiner. 2 The mean number and total diameter of the HCC nodules were 2 6 1 and 46 6 29 mm, respectively, upon pathological analysis. Before transplantation, all patients were treated with transarterial chemoembolization or combined transarterial chemoembolization and radio frequency ablation; the mean necrosis value was 67% 6 39% for the HCC nodules upon pathological analysis. Finally, the 1-, 3-, and 5-year patient and graft survival rates were 84.6%, 84.6%, and 70.5% and 84.6%, 84.6%, and 84.6%, respectively, with a median follow-up of 35 months (range ¼ 2-73 months). In conclusion, our experience seems to be comparable to the experience reported by Vibert et al. except for the absence of HCC recurrence, which was present in 23.8% of the patients investigated in the French cohort.