Multimodality Therapy and Liver Transplantation in Patients With Cirrhosis and Hepatocellular Carcinoma

6 Years, Single-Center Experience

Daniel Maluf, R. T. Stravitz, B. Williams, A. H. Cotterell, Valeria Mas, D. Heuman, V. Luketic, M. L. Shiffman, R. Sterling, M. P. Posner, R. A. Fisher

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The treatment of patients with cirrhosis and hepatocellular carcinoma (HCC) has improved dramatically over the past 10 years. We conducted a 6-year prospective study, using multimodality ablation therapy (MMT) combined with liver transplantation (LTx) for patients with cirrhosis and unresectable HCC. Subjects were classified as: group 1 (n = 35), intention to treat with MMT + LTx; group 2 (n = 16), contemporaneous LTx with "incidental" HCC on explants; group 3 (n = 94), MMT alone; and group 4 (n = 19), palliative care alone. MMT included trans-arterial chemo-embolization (54.4%), trans-arterial chemo-infusion (28.6%), and radio frequency ablation (17%). Group 1, with a mean wait time of 11.6 months pre-MELD era and 5.4 months post-MELD era, had a mean of 2.4 ± 1.2 MMTs and achieved 1- 3-, and 5-year patient survivals of 100, 100, and 76%, respectively, which was not different from group 2 (incidental HCC), namely 93, 93, and 93%, respectively; or to a contemporaneous non-HCC LTx group: namely 84.3, 78.7, and 73.9%, respectively. Despite careful pretransplant HCC staging, 22.8% (8 of 35) group 1 subjects were understaged. Those subjects in group 1 with true T1-2 stage HCC achieved 100% cancer-free survival at 5 years. Only three cases of HCC recurrence occurred in our series, all of whom were understaged. Our data suggest that pretransplant MMT followed by timely LTx provides excellent disease-free survival at 5 years for patients with true T1-2 stage HCC and cirrhosis. Pretransplant HCC understaging contributes to posttransplant HCC recurrence after LTx.

Original languageEnglish (US)
Pages (from-to)153-159
Number of pages7
JournalTransplantation Proceedings
Volume39
Issue number1
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

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Liver Transplantation
Hepatocellular Carcinoma
Fibrosis
Therapeutics
Recurrence
Survival
Radio
Palliative Care
Disease-Free Survival
Prospective Studies
Carcinoma

All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

Cite this

Multimodality Therapy and Liver Transplantation in Patients With Cirrhosis and Hepatocellular Carcinoma : 6 Years, Single-Center Experience. / Maluf, Daniel; Stravitz, R. T.; Williams, B.; Cotterell, A. H.; Mas, Valeria; Heuman, D.; Luketic, V.; Shiffman, M. L.; Sterling, R.; Posner, M. P.; Fisher, R. A.

In: Transplantation Proceedings, Vol. 39, No. 1, 01.01.2007, p. 153-159.

Research output: Contribution to journalArticle

Maluf, D, Stravitz, RT, Williams, B, Cotterell, AH, Mas, V, Heuman, D, Luketic, V, Shiffman, ML, Sterling, R, Posner, MP & Fisher, RA 2007, 'Multimodality Therapy and Liver Transplantation in Patients With Cirrhosis and Hepatocellular Carcinoma: 6 Years, Single-Center Experience', Transplantation Proceedings, vol. 39, no. 1, pp. 153-159. https://doi.org/10.1016/j.transproceed.2006.10.029
Maluf, Daniel ; Stravitz, R. T. ; Williams, B. ; Cotterell, A. H. ; Mas, Valeria ; Heuman, D. ; Luketic, V. ; Shiffman, M. L. ; Sterling, R. ; Posner, M. P. ; Fisher, R. A. / Multimodality Therapy and Liver Transplantation in Patients With Cirrhosis and Hepatocellular Carcinoma : 6 Years, Single-Center Experience. In: Transplantation Proceedings. 2007 ; Vol. 39, No. 1. pp. 153-159.
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