Department of Surgical and Gastroenterological Sciences, Section of Gastroenterology, University of Padova bDepartment of Surgical and Gastroenterological Sciences, Hepatobiliary Surgery and Liver Transplant Unit, University of Padova cDepartment of Clinical and Experimental Medicine, University of Padova dI.R.C.C.S Venetian Institute of Oncology (IOV), Padova eDepartment of Internal Medicine, Bolognini Hospital, Seriate (MI) fDepartment of Medicine, Hospital Treviglio-Caravaggio, Treviglio (BG) gDepartment of Clinical Medicine, Alma Mater Studiorum-University of Bologna, Bologna hDepartment of Medicine, Gastroenterological Unit, Hospital Fatebenefratelli, Milano iDepartment of Internal Medicine, Section of Gastroenterology, University of Genova, Genova jUnit of Gastroenterology, Hospital Belcolle, Viterbo kDepartment of Internal Medicine, Catholic University of Rome, Rome, Italy.
INTRODUCTION: 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.