Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis

✍ Scribed by Mazzaferro, Vincenzo; Regalia, Enrico; Doci, Roberto; Andreola, Salvatore; Pulvirenti, Andrea; Bozzetti, Federico; Montalto, Fabrizio; Ammatuna, Mario; Morabito, Alberto; Gennari, Leandro

• Book ID: 121793861
• Publisher: Massachusetts Medical Society
• Year: 1996
• Tongue: English
• Weight: 129 KB
• Volume: 334
• Category: Article
• ISSN: 0096-6762
• DOI: 10.1056/NEJM199603143341104

✦ Synopsis

Background. The role of orthotopic liver transplantation in the treatment of patients with cirrhosis and hepatocellular carcinoma is controversial, and determining which patients are likely to have a good outcome after liver transplantation is difficult.

Methods. We studied 48 patients with cirrhosis who had small, unresectable hepatocellular carcinomas and who underwent liver transplantation. In 94 percent of the patients, the cirrhosis was related to infection with hepatitis B virus, hepatitis C virus, or both. The presence of tumor was confirmed by biopsy or serum alpha-fetoprotein assay. The criteria for eligibility for transplantation were the presence of a tumor 5 cm or less in diameter in patients with single hepatocellular carcinomas and no more than three tumor nodules, each 3 cm or less in diameter, in patients with multiple tumors. Twenty-eight patients with sufficient hepatic function underwent treatment for the tumor, mainly chemoembolization, before transplantation. After liver transplantation, the patients were followed prospectively for a median of 26 months (range, 9 to 54). No anticancer treatment was given after transplantation.

Results. The overall mortality rate was 17 percent. Af-