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Factors Associated With recurrence After Liver transplantation For
Hepatocellular Carcinoma
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T. Decaens, 1 F. Roudot-Thoraval, 1 S. Hadni-Bresson, 2 P. Wolf, 3 J.
Gugenheim, 4 F. Durand, 5 M. Neau-Cransac, 6 O. Boillot, 7 K. Boudjema, 8 Y.
Calmus, 9 J. Hardwigsen, 10 C. Ducerf, 11 G. Pageaux, 12 S. Dharancy, 13 O.
Chazoullieres, 14 D. Dhumeaux, 1 D. Cherqui, 1
C. Duvoux*, 1 *Presenting Author
1Liver Transplantation Units of 1Hopital Henri Mondor, Creteil, 2Hopital
Jean Minjoz, Besancon, 3Hopital Hautepierre, Strasbourg, 4Hopital L'archet 2,
Nice, 5Hopital Beaujon, Clichy, 6Hopital Pellegrin, Bordeux, 7Hopital Edouard
Herriot, Lyon, 8Hopital Ponchaillou, Rennes, 9Hopital Cochin, Paris,
10Hopital La Conception, Marseille, France
Aim: The aim of this study was to assess factors associated with HCC
recurrence and disease-free survival after liver transplantation (LT).
Patients and Methods: 412 patients transplanted for HCC between 1985 and
1998 in 14 French centers, who had not died postoperatively were studied.
Kaplan Meier estimates were calculated for 40 variables with potential
association with recurrence. A uni- and multivariate analysis was conducted
to identified independent predictors of recurrence.
Results: Overall 5-year disease-free survival was 55%. By univariate
analysis, variables associated with disease-free survival were: etiology of
liver disease (p=0.03), presence of cirrhosis (p=0.001), alfa foeto-protein
level ( p=0.001), _GT activity (p=0.02), the number of nodules (1, 2-3 or
>=4; p=0.03), maximal diameter of the largest nodule (<3 cm, 3 to 5 cm or >5
cm; p<0.0001), the sum of the diameter of the nodules (p<0.0001), bi-lobar
location (p=0.01), preoperative portal thrombosis (p<0.0001), pre- or post-LT
treatment (p=0.006), tumor differentiation (p=0.007), the use of
antilymphocyte antibodies (p=0.009), rejection episodes (p=0.003) and time of
LT (p<0.0001). By multivariate analysis, 6 variables were independently
associated with HCC recurrence: maximal diameter of the largest nodule
(p<0.0001), time of LT (p<0.0001), the tumor differentiation (p<0.0001), the
use of ATG or OKT3 (p=0.005), preoperative portal thrombosis (p=0.08) and the
number of nodules (p=0.06) .
Conclusion: This study a) confirms the prognostic value of tumour
differentiation, b) does not confirm the prognostic value of bi-lobar
distribution of the tumor, c) identifies the use of ATG or OKT3 as a new
predictive factor of tumor recurrence.
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