Hepatocellular Carcinoma Impact of Waiting List and Preoperative Treatment Strategies on Survival of Cadaveric Liver Transplantation in PreMELD Era in One Center in Brazil

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Hepatocellular Carcinoma: Impact of Waiting List and Pre-operative Treatment Strategies on Survival of Cadaveric Liver Transplantation in Pre-MELD Era in One Center in Brazil Alexandre Coutinho Teixeira de Freitas, MD; PhD Mônica Beatriz Parolin, MD; PhD Lucinei Stadnik, MD Júlio Cezar Uili Coelho, MD; PhD Liver Transplantation Program Federal University of Paraná Brazil

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AIM Analyse liver transplantation 3 month and 1 year survival in: Group 1 – patients with cirrhosis and hepatocellular carcinoma Group 2 – patients with cirrhosis only

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MATERIAL AND METHODS Liver transplants done between 2001 and 2006 Group 1 Cirrhosis + hepatocellular carcinoma (diagnosed with the Barcelona criteria) Group 2 Cirrhosis Analysis comparing the 2 groups Recipient: age, sex, etiology of cirrhosis, Child-Pugh classification, MELD score, warm ischemia time, transfusion of red blood cells (units), hospital stay, intensive care unit stay and 3 months and 1 year survival Donor: age, sex and cold ischemia time

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MATERIAL AND METHODS Liver transplants done between 2001 and 2006 Group 1 Cirrhosis + hepatocellular carcinoma (diagnosed through the Barcelona criteria) Group 2 Cirrhosis Specific considerations of group 1 Local treatment – transarterial chemoembolization or percutaneous ethanol injection according to localization and number of nodules Liver transplantation – according to Milan criteria

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MATERIAL AND METHODS Liver transplants done between 2001 and 2006 Group 1 Cirrhosis + hepatocellular carcinoma (HCC) (diagnosed through the Barcelona criteria) Group 2 Cirrhosis Analysis done in group 1 only Time from diagnosis of HCC to transplant, number and diameter of the nodules at the time of the diagnosis (imaging studies), number of sessions of the local treatment, diameter of the nodules at the time of liver transplant (imaging studies), pathological examination (diameter of the nodules, angiolynphatic invasion, capsule invasion, Edmondson-Steiner classification)

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STATISTICAL ANALYSIS Kaplan-Meier univariate survival analysis with Log Rank test Student t test for mean values Qui-square test for proportions Level of significance 5% (p?0,05)

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RESULTS N=146 patients analysed 75 excluded (incomplete data) 71 included in the study The 2 groups were the same in terms of: age, sex, cold isquemia time, warm isquemia time, hospital stay, intensive care unit stay and transfusion of red blood cells (units)

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RESULTS N=146 patients analysed 75 excluded (incomplete data) 71 included in the study Cirrhosis + hepatocellular carcinoma N=12 Cirrhosis N=59 See next slide

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HCC – hepatocellular carcinoma

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RESULTS LOCAL TREATMENT Group cirrhosis + hepatocellular carcinoma (HCC)

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RESULTS LOCAL TREATMENT Local treatment provided good size control of the nodules The diameter of the nodules just before liver transplant was smaller than the diameter at the time of the diagnosis (19,3 ?16 months earlier) The diameter of the nodules of the explant was the same than the diameter at the time of the diagnosis and the diameter just before the transplant

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*p=0,02 in comparison with the diameter at the time of the diagnosis ** Not different in relation to the diameter at the time of the diagnosis (p=0,13) and the diameter just before the transplant (p=0,16). Group cirrhosis + hepatocellular carcinoma (HCC) RESULTS LOCAL TREATMENT

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CUMULATIVE 3 MONTHS SURVIVAL (GROUPS) Cirrhosis = 72,8% Cirrhosis + HCC = 100% p=0,04 Cumulative survival Days Patients with cirrhosis and HCC presented better 3 month survival than patients with cirrhosis only HCC – hepatocellular carcinoma

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CUMULATIVE 1 YEAR SURVIVAL (GROUPS) Cumulative survival Cirrhosis = 69,4% Cirrhosis + HCC = 100% p=0,02 Days Patients with cirrhosis and HCC presented better 1 year survival than patients with cirrhosis only HCC – hepatocellular carcinoma

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CONCLUSION Cirrhotic patients with hepatocellular carcinoma presented better 3 month and 1 year survival than patients with cirrhosis only. This is associated with transplantation at an early stage of cirrhosis. Local treatment provided good size control of the nodules

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