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Hcc surveillance post liver transplant

Monika Sarkar, Jennifer L Dodge, John P Roberts, Norah Terrault, Francis Yao, Neil Mehta
UNLABELLED:  Introduction. Men have higher risk for hepatocellular carcinoma (HCC) than women. Pre liver transplant (LT) alpha fetoprotein (AFP) levels strongly predict post LT HCC recurrence. Though women with HCC have higher AFP, the contribution of AFP level by gender to post LT HCC recurrence is unknown. MATERIAL AND METHODS: In this UNOSbased, retrospective cohort study we investigate sex differences in HCC recurrence among LT recipients with MELD exception between 2006-2010...
July 2016: Annals of Hepatology
Ann M Harper, Erick Edwards, W Kenneth Washburn, Julie Heimbach
In April 2012, the Organ Procurement and Transplantation Network (OPTN) implemented an online explant pathology form for recipients of liver transplantation who received additional wait-list priority for their diagnosis of hepatocellular carcinoma (HCC). The purpose of the form was to standardize the data being reported to the OPTN, which had been required since 2002 but were submitted to the OPTN in a variety of formats via facsimile. From April 2012 to December 2014, over 4500 explant forms were submitted, allowing for detailed analysis of the characteristics of the explanted livers...
June 2016: Liver Transplantation
Deepali Jain
The current American Association for the Study of Liver Diseases (AASLD) guideline provides strategies for achieving the diagnosis of hepatocellular carcinoma (HCC) based on the size of liver nodules seen on surveillance imaging. For lesions less than 1 cm in size, follow-up surveillance imaging is recommended. Lesions larger than 2 cm require typical radiological hallmark on dynamic imaging. Lesions of 1-2 cm in size require typical imaging features including intense uptake of contrast during arterial phases followed by decreased enhancement during portal venous phases on at least 2 imaging modalities...
August 2014: Journal of Clinical and Experimental Hepatology
Vatche G Agopian, Michael Harlander-Locke, Ali Zarrinpar, Fady M Kaldas, Douglas G Farmer, Hasan Yersiz, Richard S Finn, Myron Tong, Jonathan R Hiatt, Ronald W Busuttil
BACKGROUND: Although radiologic size criteria (Milan/University of California, San Francisco [UCSF]) have led to improved outcomes after liver transplantation (LT) for hepatocellular carcinoma (HCC), recurrence remains a significant challenge. We analyzed our 30-year experience with LT for HCC to identify predictors of recurrence. STUDY DESIGN: A novel clinicopathologic risk score and prognostic nomogram predicting post-transplant HCC recurrence was developed from a multivariate competing-risk Cox regression analysis of 865 LT recipients with HCC between 1984 and 2013...
April 2015: Journal of the American College of Surgeons
M R Pinzone, A M Zanghì, L Rapisarda, V D'Agata, F Benanti, D Spartà, G Nunnari, B Cacopardo
INTRODUCTION: Hepatitis C virus (HCV) infection is a common cause of chronic liver disease and hepatocellular carcinoma (HCC). The prevalence of HCC significantly declines among patients achieving a sustained virological response (SVR) after antiviral therapy with pegylated(PEG)-interferon (IFN) and ribavirin. However, up to 5% of patients with SVR may develop HCC. PATIENTS AND METHODS: We investigated the epidemiological, clinical, biochemical and virological characteristics of a small cohort of patients with chronic hepatitis C (CHC) who developed HCC after being successfully treated with PEG-IFN-α and ribavirin...
December 2014: European Review for Medical and Pharmacological Sciences
Rossano Girometti, Giuseppe Como, Massimo Bazzocchi, Chiara Zuiani
Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT...
May 28, 2014: World Journal of Gastroenterology: WJG
Pardha Devaki, Robert J Wong, Vidyasagargoud Marupakula, Sharad Nangia, Long Nguyen, Ivo C Ditah, Murray N Ehrinpreis, Mindie H Nguyen
BACKGROUND: Since 2002, priority Model for End-stage Liver Disease (MELD) exception status has been given to patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. Since then, the number of liver transplantations performed in patients with HCC has increased, but to the authors' knowledge, few studies to date have examined the effect of MELD exception recommendations on therapy use and survival rates in a nationwide sample. The current study examines therapy use and long-term survival rates among patients with HCC tumors meeting the Milan criteria in the post-MELD exception era...
June 1, 2014: Cancer
Saloni Malik, Fumiko Dekio, Jessica W Wen
HCV infection is the leading cause of liver transplantation in the adult population in the United States. HCV infection occurs in 0.2-0.4% of the pediatric population and progression to HCC is uncommon. Liver transplantation for HCV in children is rare. In this report, we present a case of pediatric patient with HCV and multifocal HCC at the age of 13 who underwent successful liver transplantation. While good graft function was initially observed, at one month after transplant, he experienced significant hepatitis C recurrence...
March 2014: Pediatric Transplantation
G Felga, A S Evangelista, P R Salvalaggio, L A Curvelo, B Della Guardia, M D Almeida, R C Afonso, B H Ferraz-Neto
INTRODUCTION: Orthotopic liver transplantation (OLT) is an excellent option for patients with unresectable hepatocellular carcinoma (HCC) within the Milan criteria. Recurrence of HCC has a severe impact on post-OLT survival. In this study, we performed an analysis of post-OLT recurrence pattern of HCC. METHODS: The prospective cohort of OLT patients included those with unresectable HCC within the Milan criteria, and those beyond the Milan criteria who were downstaged with transcatheter arterial embolization until they achieved the Milan criteria...
October 2012: Transplantation Proceedings
Pratima Sharma, Kathy Welch, Hero Hussain, Shawn J Pelletier, Robert J Fontana, Jorge Marrero, Robert M Merion
BACKGROUND AND AIMS: Deceased donor liver transplantation (DDLT) rates for candidates with hepatocellular carcinoma (HCC) have significantly increased in the MELD era because of the extra priority given to these candidates. We examined the incidence and pre-DDLT radiological and donor factors associated with post-DDLT HCC recurrence in the MELD era. METHODS: Outcomes of HCC candidates aged ≥18 years that underwent DDLT between 2/28/02 and 6/30/08 (n = 94) were reviewed...
March 2012: Digestive Diseases and Sciences
Kenneth S H Chok, See Ching Chan, Tan To Cheung, Albert C Y Chan, Sheung Tat Fan, Chung Mau Lo
BACKGROUND: Long-term survival of patients with hepatocellular carcinoma (HCC) after liver transplantation is affected mainly by recurrence of HCC. There is the opinion that the chance of recurrence after 2 years post-transplantation is remote, and therefore lifelong surveillance is not justified because of limited resources. The aims of the present study were to determine the rate of late HCC recurrence (≥ 2 years after transplantation) and to compare the long-term patient survival outcomes between cases of early recurrence (<2 years after transplantation) and late recurrence...
September 2011: World Journal of Surgery
Shin Hwang, Chul-Soo Ahn, Ki-Hun Kim, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Young-Dong Yu, Pyoung-Jae Park, Young-Il Choi, Kyoung-Won Kim, Young-Suk Lim, Han Chu Lee, Eun-Sil Yu, Sung-Gyu Lee
BACKGROUND: A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liver DISCUSSION: Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed...
June 2011: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Robert Wong, Catherine Frenette
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and its increasing incidence worldwide is a cause for concern. Fortunately, advances in diagnostic and therapeutic approaches have contributed to earlier detection and treatment. As cancer epidemiology studies continue to elucidate the natural history of liver diseases, greater understanding of HCC has led to improved risk stratification and earlier enrollment of high-risk patients in cancer screening and surveillance programs. Improved survival rates among HCC patients also reflect significant advances in available treatment options...
January 2011: Gastroenterology & Hepatology
Kishore Maganty, David Levi, Jang Moon, Pablo A Bejarano, Leopoldo Arosemena, Andreas Tzakis, Paul Martin
BACKGROUND: Combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma is a rare hepatobiliary malignancy incorporating components derived from both hepatocyte and intrahepatic bile duct epithelium. The natural history, treatment, and prognosis of this distinct cancer differ from hepatocellular carcinoma (HCC) or cholangiocarcinoma (CC) and are not completely understood. There is considerable controversy about the classification, treatment, and survival, which in turn is related to the rarity of the condition...
December 2010: Digestive Diseases and Sciences
Noriyo Yamashiki, Yasuhiko Sugawara, Sumihito Tamura, Ryosuke Tateishi, Haruhiko Yoshida, Junichi Kaneko, Yuichi Matsui, Junichi Togashi, Masaaki Akahane, Masatoshi Makuuchi, Masao Omata, Norihiro Kokudo
AIM: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation decreases patient survival. The usefulness of post-transplant surveillance with tumor markers, however, is not clear. We evaluated our cumulative experience with recurrent HCC detected during post-transplant surveillance. METHODS: We analyzed 100 patients with HCC detected in the explanted liver. Monthly to bimonthly measurement of tumor markers and yearly computed tomography were scheduled postoperatively...
April 2010: Hepatology Research: the Official Journal of the Japan Society of Hepatology
J Thompson Coon, G Rogers, P Hewson, D Wright, R Anderson, M Cramp, S Jackson, S Ryder, A Price, K Stein
OBJECTIVES: To evaluate the effectiveness, cost-effectiveness and cost-utility of surveillance of patients with cirrhosis [alcoholic liver disease (ALD)-, hepatitis B (HBV)- and C virus (HCV)-related], using periodic serum alpha-fetoprotein (AFP) testing and/or liver ultrasound examination, to detect hepatocellular carcinoma (HCC), followed by treatment with liver transplantation or resection, where appropriate. DATA SOURCES: Electronic databases were searched up to March 2006...
September 2007: Health Technology Assessment: HTA
I R Schreibman, P Bejarano, E J Martinez, A Regev
Hepatocellular carcinoma (HCC) recurs in 10% to 60% of the patients after liver transplantation (OLT) and is associated with increased mortality. The average time to recurrence ranges from 1 to 2 years following OLT, and the median survival from the time of diagnosis is about 1 year. We report a case of a 69-year-old man who underwent OLT for hepatitis C virus-related cirrhosis with HCC, and was diagnosed with recurrent HCC 6.5 years after OLT. Biopsies from the initial and recurrent tumors showed a well-differentiated HCC with foci of clear cell pattern...
November 2006: Transplantation Proceedings
John P Roberts
1. The overall rate of recurrence of hepatocellular carcinoma (HCC) after liver transplantation ranged from 11 to 18% in three of the largest series, with some differences in pre-transplant selection criteria. 2. Patients whose explant pathology is within the currently accepted criteria for transplantation have a low rate of recurrence (8%). Patients whose pathology is outside of the criteria have a 50% chance of recurrence, suggesting that post-operative pathology should be used to stratify screening. 3. About 10% of patients with recurrence appear to be long-term survivors after surgical therapy for the recurrence...
November 2005: Liver Transplantation
Grace Guzman, Victoria Alagiozian-Angelova, Jennifer E Layden-Almer, Thomas J Layden, Guiliano Testa, Enrico Benedetti, André Kajdacsy-Balla, Scott J Cotler
Patients with hepatocellular carcinoma who undergo orthotopic liver transplantation (OLT) are at risk for post-transplant tumor recurrence. The aim of this study was to evaluate whether expression of p53 and Ki-67 in hepatocellular carcinoma lesions present in explanted liver tissue was associated with time to tumor recurrence after OLT. Subjects consisted of 20 consecutive patients who underwent OLT and were found to have hepatocellular carcinoma in the liver explant. Immunostaining for p53 and Ki-67 was performed by standard methods...
November 2005: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
M Berenguer, M Prieto, M Bustamante, D Carrasco, R López-Andújar, J Mir, J Berenguer
BACKGROUND: De novo malignancy developing after transplantation constitutes a well-known complication or organ transplantation, mainly described among renal recipients. AIM: To determine the incidence of de novo internal malignancies (excluding therefore skin cancers and recurrent hepatocellular carcinoma) in a cohort of 183 patients undergoing liver transplantation (OLT) between 6/1/1991 and 12/1/1996 with a minimum follow-up of 12 months and under cyclosporine-azathioprine-prednisone...
October 24, 1998: Medicina Clínica
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