Antiviral Prophylaxis and Recurrence of Hepatocellular Carcinoma Following Liver Transplantation in

[Guest guest]

Liver transplantation

Antiviral Prophylaxis and Recurrence of Hepatocellular Carcinoma Following Liver

Transplantation in Patients With Hepatitis B

M.A. Zimmermana, R.M. Ghobriala, M.J. Tonga, J.R. Hiatta, A.M. Camerona and R.W.

Busuttil, a,

aDepartment of Surgery, Division of Liver and Pancreas Transplantation, The

Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The Geffen

School of Medicine at the University of California Los Angeles, Los Angeles,

California, USA.

Available online 21 December 2007.

Abstract

Background

Orthotopic liver transplantation (OLT) is a viable treatment option for patients

with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However,

cancer recurrence following transplantation approaches 20%. This study sought to

identify the clinical and pathological factors associated with post-OLT

survival.

Methods

Univariate and multivariate analyses considered the following variables:

combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion,

distribution, nodularity, pre- and post-OLT tumor size, pre-OLT

alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race.

Results

Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5

years, respectively, and was significantly better in patients who were free of

viral recurrence post-OLT. Similarly, patients treated with combination

prophylaxis had a significantly lower mortality than those who were not.

Conclusions

Multivariate analysis revealed that AFP> 500 ng/mL, presence of vascular

invasion by explant, HBV recurrence, and combination prophylaxis were

independent predictors of HCC recurrence-free survival.

This work was supported in part by The Dumont Foundation, The Pfleger Liver

Institute, and The Joanne Barr Foundation.

Address reprint requests to W. Busuttil, MD, PhD, The Dumont-UCLA

Transplant Center, 77-120 CHS, Box 957054, 10833 Le Conte Ave, Los Angeles, CA

90095-7054.

Transplantation Proceedings

Volume 39, Issue 10, December 2007, Pages 3276-3280

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6VJ0-4RD9KMT-2M & _user=\

10 & _coverDate=12%2F31%2F2007 & _rdoc=74 & _fmt=summary & _orig=browse & _srch=doc-info(%\

23toc%236080%232007%23999609989%23677001%23FLA%23display%23Volume) & _cdi=6080 & _so\

rt=d & _docanchor= & _ct=139 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md\

5=18a3f54fc13ef85002d0379badf80152

_________________________________________________________________

Share life as it happens with the new Windows Live.

http://www.windowslive.com/share.html?ocid=TXT_TAGHM_Wave2_sharelife_012008

[Guest guest]

Liver transplantation

Antiviral Prophylaxis and Recurrence of Hepatocellular Carcinoma Following Liver

Transplantation in Patients With Hepatitis B

M.A. Zimmermana, R.M. Ghobriala, M.J. Tonga, J.R. Hiatta, A.M. Camerona and R.W.

Busuttil, a,

aDepartment of Surgery, Division of Liver and Pancreas Transplantation, The

Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The Geffen

School of Medicine at the University of California Los Angeles, Los Angeles,

California, USA.

Available online 21 December 2007.

Abstract

Background

Orthotopic liver transplantation (OLT) is a viable treatment option for patients

with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However,

cancer recurrence following transplantation approaches 20%. This study sought to

identify the clinical and pathological factors associated with post-OLT

survival.

Methods

Univariate and multivariate analyses considered the following variables:

combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion,

distribution, nodularity, pre- and post-OLT tumor size, pre-OLT

alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race.

Results

Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5

years, respectively, and was significantly better in patients who were free of

viral recurrence post-OLT. Similarly, patients treated with combination

prophylaxis had a significantly lower mortality than those who were not.

Conclusions

Multivariate analysis revealed that AFP> 500 ng/mL, presence of vascular

invasion by explant, HBV recurrence, and combination prophylaxis were

independent predictors of HCC recurrence-free survival.

This work was supported in part by The Dumont Foundation, The Pfleger Liver

Institute, and The Joanne Barr Foundation.

Address reprint requests to W. Busuttil, MD, PhD, The Dumont-UCLA

Transplant Center, 77-120 CHS, Box 957054, 10833 Le Conte Ave, Los Angeles, CA

90095-7054.

Transplantation Proceedings

Volume 39, Issue 10, December 2007, Pages 3276-3280

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6VJ0-4RD9KMT-2M & _user=\

10 & _coverDate=12%2F31%2F2007 & _rdoc=74 & _fmt=summary & _orig=browse & _srch=doc-info(%\

23toc%236080%232007%23999609989%23677001%23FLA%23display%23Volume) & _cdi=6080 & _so\

rt=d & _docanchor= & _ct=139 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md\

5=18a3f54fc13ef85002d0379badf80152

_________________________________________________________________

Share life as it happens with the new Windows Live.

http://www.windowslive.com/share.html?ocid=TXT_TAGHM_Wave2_sharelife_012008

[Guest guest]

Liver transplantation

Antiviral Prophylaxis and Recurrence of Hepatocellular Carcinoma Following Liver

Transplantation in Patients With Hepatitis B

M.A. Zimmermana, R.M. Ghobriala, M.J. Tonga, J.R. Hiatta, A.M. Camerona and R.W.

Busuttil, a,

aDepartment of Surgery, Division of Liver and Pancreas Transplantation, The

Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The Geffen

School of Medicine at the University of California Los Angeles, Los Angeles,

California, USA.

Available online 21 December 2007.

Abstract

Background

Orthotopic liver transplantation (OLT) is a viable treatment option for patients

with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However,

cancer recurrence following transplantation approaches 20%. This study sought to

identify the clinical and pathological factors associated with post-OLT

survival.

Methods

Univariate and multivariate analyses considered the following variables:

combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion,

distribution, nodularity, pre- and post-OLT tumor size, pre-OLT

alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race.

Results

Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5

years, respectively, and was significantly better in patients who were free of

viral recurrence post-OLT. Similarly, patients treated with combination

prophylaxis had a significantly lower mortality than those who were not.

Conclusions

Multivariate analysis revealed that AFP> 500 ng/mL, presence of vascular

invasion by explant, HBV recurrence, and combination prophylaxis were

independent predictors of HCC recurrence-free survival.

This work was supported in part by The Dumont Foundation, The Pfleger Liver

Institute, and The Joanne Barr Foundation.

Address reprint requests to W. Busuttil, MD, PhD, The Dumont-UCLA

Transplant Center, 77-120 CHS, Box 957054, 10833 Le Conte Ave, Los Angeles, CA

90095-7054.

Transplantation Proceedings

Volume 39, Issue 10, December 2007, Pages 3276-3280

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6VJ0-4RD9KMT-2M & _user=\

10 & _coverDate=12%2F31%2F2007 & _rdoc=74 & _fmt=summary & _orig=browse & _srch=doc-info(%\

23toc%236080%232007%23999609989%23677001%23FLA%23display%23Volume) & _cdi=6080 & _so\

rt=d & _docanchor= & _ct=139 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md\

5=18a3f54fc13ef85002d0379badf80152

_________________________________________________________________

Share life as it happens with the new Windows Live.

http://www.windowslive.com/share.html?ocid=TXT_TAGHM_Wave2_sharelife_012008

[Guest guest]

Liver transplantation

Antiviral Prophylaxis and Recurrence of Hepatocellular Carcinoma Following Liver

Transplantation in Patients With Hepatitis B

M.A. Zimmermana, R.M. Ghobriala, M.J. Tonga, J.R. Hiatta, A.M. Camerona and R.W.

Busuttil, a,

aDepartment of Surgery, Division of Liver and Pancreas Transplantation, The

Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The Geffen

School of Medicine at the University of California Los Angeles, Los Angeles,

California, USA.

Available online 21 December 2007.

Abstract

Background

Orthotopic liver transplantation (OLT) is a viable treatment option for patients

with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However,

cancer recurrence following transplantation approaches 20%. This study sought to

identify the clinical and pathological factors associated with post-OLT

survival.

Methods

Univariate and multivariate analyses considered the following variables:

combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion,

distribution, nodularity, pre- and post-OLT tumor size, pre-OLT

alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race.

Results

Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5

years, respectively, and was significantly better in patients who were free of

viral recurrence post-OLT. Similarly, patients treated with combination

prophylaxis had a significantly lower mortality than those who were not.

Conclusions

Multivariate analysis revealed that AFP> 500 ng/mL, presence of vascular

invasion by explant, HBV recurrence, and combination prophylaxis were

independent predictors of HCC recurrence-free survival.

This work was supported in part by The Dumont Foundation, The Pfleger Liver

Institute, and The Joanne Barr Foundation.

Address reprint requests to W. Busuttil, MD, PhD, The Dumont-UCLA

Transplant Center, 77-120 CHS, Box 957054, 10833 Le Conte Ave, Los Angeles, CA

90095-7054.

Transplantation Proceedings

Volume 39, Issue 10, December 2007, Pages 3276-3280

http://www.sciencedirect.com/science?_ob=ArticleURL & _udi=B6VJ0-4RD9KMT-2M & _user=\

10 & _coverDate=12%2F31%2F2007 & _rdoc=74 & _fmt=summary & _orig=browse & _srch=doc-info(%\

23toc%236080%232007%23999609989%23677001%23FLA%23display%23Volume) & _cdi=6080 & _so\

rt=d & _docanchor= & _ct=139 & _acct=C000050221 & _version=1 & _urlVersion=0 & _userid=10 & md\

5=18a3f54fc13ef85002d0379badf80152

_________________________________________________________________

Share life as it happens with the new Windows Live.

http://www.windowslive.com/share.html?ocid=TXT_TAGHM_Wave2_sharelife_012008