C. Ekeke4, C. Hughes1, A. Humar1, A. Tsung3, S. Ganesh1,2, V. Rachakonda1,2, A. D. Tevar1 1Thomas E. Starzl Transplantation Institute,Dept. Of Surgery / Unversity Of Pittsburgh,P, PA, USA 2Division Of Gastroenterology,Hepatology & Nutition / Dept. Of Medicine / University Of Pittsburgh,Pittsburgh, P, USA 3UPMC Liver Cancer Center,Dept. Of Surgery / University Of Pittsburgh,Pittsburgh, PA, USA 4Department Of Surgery,University Of Pittsburgh Medical Center,Pittsburgh, PA, USA
Introduction: Liver transplant (LT) remains the most effecting treatment modality for management of hepatocellular carcinoma (HCC) in the end-stage liver disease population. The longterm outcomes of preoperatively known HCC treated with LT have been well characterized. Less is known about the tumor pathology and outcomes of incidentally discovered HCC found during hepatic explant pathology review. The aim of this study was to determine incidence, patient and pathologic characteristics and outcomes of incidental hepatocellular carcinoma discovered following LT in a large volume center experience.
Methods: This study retrospectively reviewed patients undergoing liver transplant at the University of Pittsburgh Medical Center from 2002 to 2013. Review of patient demographics, preoperative radiographic, tumor markers, tumor pathologic characteristics, short and long-term outcomes was performed.
Results: During the study period, 320 patients underwent LT in which HCC was known preoperatively or found on explant. The average follow up was 2035.6 days. Incidental HCC was detected in 52 of 1886 (2.8%) patients who underwent LT during that time period.. The most common indication for liver transplantation was hepatitis C. Patients with incidental HCC versus known HCC shared similarities in age (57.21 vs. 58.09 yrs), sex (78.8% and 80.2% male) and lab MELD at transplant (17.27 vs. 15.01). Average Peak and pre-transplant alpha fetal protein tumor (AFP) markers were 33.5 and 30.48 in the incidental HCC cohort and 849.2 and 337.45 in the known HCC group. Incidental HCC LT had more moderate to poorly differentiated tumor pathology (71.2% vs. 58.2%, p value = <0.05) and similar numbers of well (23.1% vs. 21.3%) and poorly (5.8% vs. 6.3%) differentiated lesions. Lack of vascular invasion was similar between the two groups (73.1% vs 66.4% ), in incidental HCC and known HCC, respectively. HCC recurrence was 9.6% in incidental HCC and 12.7% in known HCC.
Conclusion: We present a large volume experience with incidental HCC found after LT. Patient demographics, recurrence and survival outcomes were similar in incidental and known HCC LT recipients. Pathological findings were comparable in size, with evidence of more moderately-poorly differentiated tumors in the incidental HCC group.