Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant

Moustafa Mabrouk Mourad; Abdullah Algarni; Menna-Allah Aly; Bridget K Gunson; Hynek Mergental; John Isaac; Paolo Muiesan; Darius Mirza; M Thamara P R Perera; Simon R Bramhall

Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant

Moustafa Mabrouk Mourad, Abdullah Algarni, Menna-Allah Aly, Bridget K Gunson, Hynek Mergental, John Isaac, Paolo Muiesan, Darius Mirza, M Thamara P R Perera, Simon R Bramhall

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

OBJECTIVES: Orthotopic liver transplant is the treatment of choice for hepatocellular carcinoma in cirrhotic patients with satisfactory oncologic and survival outcomes. Incidental hepatocellular carcinoma is frequently a reported finding in the explant pathology after orthotopic liver transplant.

MATERIAL AND METHODS: The present study retrospectively analyzed the tumor characteristics and outcomes of 50 incidental hepatocellular carcinomas compared with 252 transplants for known hepatocellular carcinoma.

RESULTS: Patients with incidental hepatocellular carcinoma had lower peak alpha-fetoprotein level (P = .001), lower pretransplant alpha-fetoprotein level (P = .002), smaller total tumor size (P = .0001), fewer tumor numbers (P = .0001), lower level of microvascular invasion (P = .001), more cases within Milan criteria (P = .005), and more well-differentiated tumors (P = .017). However, no difference in survival rates was observed between the 2 groups. In 35 patients (70%) who had incidental hepatocellular carcinoma, pretransplant imaging studies were normal; ultrasonography was used as the only screening tool in 25 of 35 patients (71%) who had incidental hepatocellular carcinoma, and 15 patients (30%) who had incidental hepatocellular carcinoma had regenerative or dysplastic nodules. The accuracy of ultrasonography in our unit for diagnosing hepatocellular carcinoma was 97.5%. A quarter of hepatitis B recipients had incidental hepatocellular carcinoma with a younger median recipient age. Tumor recurrence was higher with incidental hepatocellular carcinoma in hepatitis C recipients (22%). However, the overall recurrence was similar between all hepatitis and nonhepatitis recipients who were transplanted for incidental or known hepatocellular carcinoma.

CONCLUSIONS: Incidental hepatocellular carcinoma has similar outcome as known hepatocellular carcinoma. Early screening of hepatitis B patients is recommended, and cross-sectional imaging is not mandatory for hepatocellular carcinoma screening in patients who are on the waiting list.

Original language	English
Pages (from-to)	333-8
Number of pages	6
Journal	Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
Volume	13
Issue number	4
Publication status	Published - Aug 2015

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Mourad, M. M., Algarni, A., Aly, M.-A., Gunson, B. K., Mergental, H., Isaac, J., Muiesan, P., Mirza, D., Perera, M. T. P. R., & Bramhall, S. R. (2015). Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 13(4), 333-8.

@article{5b9974c4cc7c4247b26c9c9d4ab1e953,

title = "Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant",

abstract = "OBJECTIVES: Orthotopic liver transplant is the treatment of choice for hepatocellular carcinoma in cirrhotic patients with satisfactory oncologic and survival outcomes. Incidental hepatocellular carcinoma is frequently a reported finding in the explant pathology after orthotopic liver transplant.MATERIAL AND METHODS: The present study retrospectively analyzed the tumor characteristics and outcomes of 50 incidental hepatocellular carcinomas compared with 252 transplants for known hepatocellular carcinoma.RESULTS: Patients with incidental hepatocellular carcinoma had lower peak alpha-fetoprotein level (P = .001), lower pretransplant alpha-fetoprotein level (P = .002), smaller total tumor size (P = .0001), fewer tumor numbers (P = .0001), lower level of microvascular invasion (P = .001), more cases within Milan criteria (P = .005), and more well-differentiated tumors (P = .017). However, no difference in survival rates was observed between the 2 groups. In 35 patients (70%) who had incidental hepatocellular carcinoma, pretransplant imaging studies were normal; ultrasonography was used as the only screening tool in 25 of 35 patients (71%) who had incidental hepatocellular carcinoma, and 15 patients (30%) who had incidental hepatocellular carcinoma had regenerative or dysplastic nodules. The accuracy of ultrasonography in our unit for diagnosing hepatocellular carcinoma was 97.5%. A quarter of hepatitis B recipients had incidental hepatocellular carcinoma with a younger median recipient age. Tumor recurrence was higher with incidental hepatocellular carcinoma in hepatitis C recipients (22%). However, the overall recurrence was similar between all hepatitis and nonhepatitis recipients who were transplanted for incidental or known hepatocellular carcinoma.CONCLUSIONS: Incidental hepatocellular carcinoma has similar outcome as known hepatocellular carcinoma. Early screening of hepatitis B patients is recommended, and cross-sectional imaging is not mandatory for hepatocellular carcinoma screening in patients who are on the waiting list.",

author = "Mourad, {Moustafa Mabrouk} and Abdullah Algarni and Menna-Allah Aly and Gunson, {Bridget K} and Hynek Mergental and John Isaac and Paolo Muiesan and Darius Mirza and Perera, {M Thamara P R} and Bramhall, {Simon R}",

year = "2015",

month = aug,

language = "English",

volume = "13",

pages = "333--8",

journal = "Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation",

issn = "1304-0855",

publisher = "Baskent University",

number = "4",

}

Mourad, MM, Algarni, A, Aly, M-A, Gunson, BK, Mergental, H, Isaac, J, Muiesan, P, Mirza, D, Perera, MTPR & Bramhall, SR 2015, 'Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant', Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, vol. 13, no. 4, pp. 333-8.

Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant. / Mourad, Moustafa Mabrouk; Algarni, Abdullah; Aly, Menna-Allah et al.
In: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Vol. 13, No. 4, 08.2015, p. 333-8.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant

AU - Mourad, Moustafa Mabrouk

AU - Algarni, Abdullah

AU - Aly, Menna-Allah

AU - Gunson, Bridget K

AU - Mergental, Hynek

AU - Isaac, John

AU - Muiesan, Paolo

AU - Mirza, Darius

AU - Perera, M Thamara P R

AU - Bramhall, Simon R

PY - 2015/8

Y1 - 2015/8

N2 - OBJECTIVES: Orthotopic liver transplant is the treatment of choice for hepatocellular carcinoma in cirrhotic patients with satisfactory oncologic and survival outcomes. Incidental hepatocellular carcinoma is frequently a reported finding in the explant pathology after orthotopic liver transplant.MATERIAL AND METHODS: The present study retrospectively analyzed the tumor characteristics and outcomes of 50 incidental hepatocellular carcinomas compared with 252 transplants for known hepatocellular carcinoma.RESULTS: Patients with incidental hepatocellular carcinoma had lower peak alpha-fetoprotein level (P = .001), lower pretransplant alpha-fetoprotein level (P = .002), smaller total tumor size (P = .0001), fewer tumor numbers (P = .0001), lower level of microvascular invasion (P = .001), more cases within Milan criteria (P = .005), and more well-differentiated tumors (P = .017). However, no difference in survival rates was observed between the 2 groups. In 35 patients (70%) who had incidental hepatocellular carcinoma, pretransplant imaging studies were normal; ultrasonography was used as the only screening tool in 25 of 35 patients (71%) who had incidental hepatocellular carcinoma, and 15 patients (30%) who had incidental hepatocellular carcinoma had regenerative or dysplastic nodules. The accuracy of ultrasonography in our unit for diagnosing hepatocellular carcinoma was 97.5%. A quarter of hepatitis B recipients had incidental hepatocellular carcinoma with a younger median recipient age. Tumor recurrence was higher with incidental hepatocellular carcinoma in hepatitis C recipients (22%). However, the overall recurrence was similar between all hepatitis and nonhepatitis recipients who were transplanted for incidental or known hepatocellular carcinoma.CONCLUSIONS: Incidental hepatocellular carcinoma has similar outcome as known hepatocellular carcinoma. Early screening of hepatitis B patients is recommended, and cross-sectional imaging is not mandatory for hepatocellular carcinoma screening in patients who are on the waiting list.

AB - OBJECTIVES: Orthotopic liver transplant is the treatment of choice for hepatocellular carcinoma in cirrhotic patients with satisfactory oncologic and survival outcomes. Incidental hepatocellular carcinoma is frequently a reported finding in the explant pathology after orthotopic liver transplant.MATERIAL AND METHODS: The present study retrospectively analyzed the tumor characteristics and outcomes of 50 incidental hepatocellular carcinomas compared with 252 transplants for known hepatocellular carcinoma.RESULTS: Patients with incidental hepatocellular carcinoma had lower peak alpha-fetoprotein level (P = .001), lower pretransplant alpha-fetoprotein level (P = .002), smaller total tumor size (P = .0001), fewer tumor numbers (P = .0001), lower level of microvascular invasion (P = .001), more cases within Milan criteria (P = .005), and more well-differentiated tumors (P = .017). However, no difference in survival rates was observed between the 2 groups. In 35 patients (70%) who had incidental hepatocellular carcinoma, pretransplant imaging studies were normal; ultrasonography was used as the only screening tool in 25 of 35 patients (71%) who had incidental hepatocellular carcinoma, and 15 patients (30%) who had incidental hepatocellular carcinoma had regenerative or dysplastic nodules. The accuracy of ultrasonography in our unit for diagnosing hepatocellular carcinoma was 97.5%. A quarter of hepatitis B recipients had incidental hepatocellular carcinoma with a younger median recipient age. Tumor recurrence was higher with incidental hepatocellular carcinoma in hepatitis C recipients (22%). However, the overall recurrence was similar between all hepatitis and nonhepatitis recipients who were transplanted for incidental or known hepatocellular carcinoma.CONCLUSIONS: Incidental hepatocellular carcinoma has similar outcome as known hepatocellular carcinoma. Early screening of hepatitis B patients is recommended, and cross-sectional imaging is not mandatory for hepatocellular carcinoma screening in patients who are on the waiting list.

M3 - Article

C2 - 26295183

SN - 1304-0855

VL - 13

SP - 333

EP - 338

JO - Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation

JF - Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation

IS - 4

ER -

Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant

Abstract

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