W. J. Bush1, C. A. Kubal1, J. A. Fridell1, B. Ekser1, R. C. Graham1, K. A. Thatch1, R. S. Mangus1 1Indiana University School Of Medicine,Transplant,Indianapolis, IN, USA
Introduction:
Liver transplant (LT) patients with hepatocellular carcinoma (HCC) are at risk for post-transplant tumor recurrence. Risk of HCC recurrence is known to be associated with the size and number of tumors present within the liver. Close proximity of tumor to major vascular structures may also increase the risk of tumor recurrence. For that reason, most surgeons employ a conventional bicaval technique, replacing the entire vena cava as part of the LT. Our center has previously published data suggesting that the vena cava-sparing piggyback (PGB) technique can be safely used without affecting clinical outcomes. This study reviews a large number of LT patients with HCC to determine long-term outcomes of using the PGB technique, as well as the impact of tumor proximity to the vena cava on recurrence rates.
Methods:
The records of all adult patients undergoing liver transplant (LT) at a single center over a 15 year period were reviewed. Patients with HCC were extracted for further analysis. The operative records for all HCC patients were reviewed to determine if the CONV or PGB hepatectomy technique was utilized. Original computed tomography scans were reviewed to measure distance between the vena cava and the nearest tumor, and to determine which segments of the liver had tumor present. Outcomes included HCC recurrence and long term patient survival. Cox regression 10-year patient survival was calculated.
Results:
There were 1722 LT patients, and 393 were found to have HCC (23%). Among these patients, 367 (93%) underwent LT with PGB technique, while 26 had CONV hepatectomy (7%). The PGB patients were older and had an older donor age, but had lower cold and warm ischemia time. The PGB patients were more likely to have HCC in segments adjacent to the vena cava (57% vs 34%, p=0.02), but the median distance to the nearest tumor was greater for the PGB group (45 vs 28mm, p=0.06). There was no significant difference in tumor recurrence between PGB and CONV (16% vs 19%, p=0.70), nor was there a difference by Cox regression in survival at 10-years (p=0.13). Predictors of recurrence included being outside Milan criteria, and increased tumor size and number, but not tumor distance to the vena cava.
Conclusion:
These results demonstrate no significant difference in clinical outcomes between the PGB and CONV surgical techniques in LT patients with HCC. Tumor presence near the vena cava was not associated with increased risk of HCC recurrence.
