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Abstract
Objectives and Aim of the Work: This work is designed to study outcome of patients who underwent living donor liver transplantation (LDLT) for HCC as regard: 1) Recurrence rate .2) Risk factors. 3) Survival rate.
Patients and Methods:This is a retrospective study for 25 adult recipients who underwent LDLT for HCC out of 129 recipients transplanted in Dar AL-Fouad Hospital in the period between August 2001 to January 2007. Preoperative and postoperative follow up were done in the form of clinical examination,CHILD score, MELD score, Milan criteria, laboratory parameters and imaging.
Results and conclusion: HCV was the main underlying etiology of end stage liver disease in our series and 19/25(76%) of our cases were within the Milan criteria. The survival rate in HCC patients was 56 %(14/25), while in non-HCC patients the survival rate was 66%
(68/103),with no significant difference. Milan criteria did not offer better results in our study except for low rate of HCC recurrence. Only 2/25(8%)showed HCC recurrence. Biliary complications were the main cause of death in this study. HCV recurrence was 24% and the mean recurrence time of HCV was 6.3±2.9 months after transplantation. Incidental lesions in the explanted liver and operative difficulties were the only predictors for poor outcome in cases transplanted for HCC in our series, while all other parameters were not predictors of survival except postoperative serum Bilirubin. Recommendations: Molecular behavior or profile for HCC should be the target for future studies as a predictor for patients’ survival and for tumor recurrence. Extended criteria for selection of HCC for transplantation should be studied on large number of patients.Recently used sirolimus as a privilege immunosuppressive anti-proliferative drug should be evaluated on large number of patients versus conventially used CNI.