Antiviral Prophylaxis and Recurrence of Hepatocellular Carcinoma Following Liver Transplantation in Patients With Hepatitis B

Abstract Background Orthotopic liver transplantation (OLT) is a viable treatment option for patients with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However, cancer recurrence following transplantation approaches 20%. This study sought to identify the clinical and pathological...

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Bibliographic Details
Published in:Transplantation proceedings 2007-12, Vol.39 (10), p.3276-3280
Main Authors: Zimmerman, M.A, Ghobrial, R.M, Tong, M.J, Hiatt, J.R, Cameron, A.M, Busuttil, R.W
Format: Article
Language:English
Subjects:
Analysis of Variance
Antiviral Agents - therapeutic use
Carcinoma, Hepatocellular - complications
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - surgery
Disease-Free Survival
Hepatitis B - complications
Hepatitis B - drug therapy
Hepatitis B - surgery
Humans
Immunoglobulins - therapeutic use
Lamivudine - therapeutic use
Liver Neoplasms - complications
Liver Neoplasms - mortality
Liver Neoplasms - surgery
Neoplasm Staging
Postoperative Complications - prevention & control
Postoperative Complications - virology
Recurrence
Retrospective Studies
Surgery
Survival Analysis
Survivors
Time Factors
Virus Diseases - epidemiology
Virus Diseases - prevention & control
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Summary:Abstract Background Orthotopic liver transplantation (OLT) is a viable treatment option for patients with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However, cancer recurrence following transplantation approaches 20%. This study sought to identify the clinical and pathological factors associated with post-OLT survival. Methods Univariate and multivariate analyses considered the following variables: combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion, distribution, nodularity, pre- and post-OLT tumor size, pre-OLT alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race. Results Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5 years, respectively, and was significantly better in patients who were free of viral recurrence post-OLT. Similarly, patients treated with combination prophylaxis had a significantly lower mortality than those who were not. Conclusions Multivariate analysis revealed that AFP > 500 ng/mL, presence of vascular invasion by explant, HBV recurrence, and combination prophylaxis were independent predictors of HCC recurrence-free survival.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2007.07.085