icon-folder.gif   Conference Reports for NATAP  
  38th Annual Meeting of the European Association for the Study of the Liver
Istanbul, Turkey. March 28-April 1, 2003
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Factors Associated With recurrence After Liver transplantation For Hepatocellular Carcinoma
  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.