الفهرس 
LIVER TRANSPLANTATIONOnly 14 pages are availabe for public view
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Abstract
R
egarding liver transplantation, It is considered a highly effective therapy for early-stage HCC because it offers optimal treatment of both the underlying liver disease and the tumor, and is associated with excellent long-term survival rates.
Despite using the morphologic criteria, such as the Milan criteria to select HCC patients for LT, tumor recurrence (TR) still occurs in 15% to 20% of cases, being associated with an unfavorable prognosis.
Measurement of inflammatory markers represents a significant tool to asses risk of HCC recurrence post LT, as the pro inflammatory effects of systemic inflammatory response (SIR) have been linked with HCC.
This study was conducted to assess the role of the inflammatory indices as prognostic markers for HCC recurrence post liver transplantation and to compare these markers with the standard parameters as AFP and micro-vascular invasion as regard HCC recurrence post liver transplantation.
To fulfill the aim of this study which was conducted at Ain-Shams University organ transplant (ASCOT) unit, 100 participants with HCC were included and characterized by the following:
Inclusion Criteria: All patients aged (18-60) years fulfilled Milan/Modified San Fransisco Criteria, underwent Living donor liver transplantation LDLT during the study period from March 2008 till March 2018.
Study Procedures: Data was retrieved from the file system of the included patients stressing on the following:
i. Full history taking and examination
ii. Laboratory investigations including CBC with differential (commenting on absolute neutrophil, lymphocyte and platelet count to calculate PLR, NLR), AFP and CRP
iii. Pre-operative Child-Turcotte-Pugh Scoring System
iv. Pre-operative model for end stage liver disease (MELD)
v. Pre-operative Radiological Assesment
vi. Post operative Histological confirmation
Results of the current study showed the total number of the studied patients are 100, 91 males and 9 females with mean age (52.26 ± 6.27) years.
The total number of patients with HCC recurrence post liver transplantation at the end of the study period was 11 out of 100 cases.
As regards the correlation between different parameters and HCC recurrence, Firstly the demographic data of the studied patients showed that there was significant relation regarding the age of the cases with mean (47.27 ± 4.92) years and HCC recurrence (P value = 0.01).
Regarding pre transplantation data of the studied cases showed that there was significant relation regarding AFP (ng/dl) with median (50 ± 66) and HCC recurrence (P value >0.01).
As regard post transplantation data of the studied patients showed that there was significant relation regarding those who had micro vascular invasion in the explant pathology and HCC recurrence (P value >0.01).
Moreover, the ROC curve of predictive ability of pre-transplant AFP for detection of HCC recurrence post LT showed that it can predict HCC recurrence with best cut off value > 17.8 ng/ml with Sensitivity 82% and Specificity 70%.
Also, the ROC curve of predictive ability of post-transplant CRP showed that it can predict HCC recurrence with best cut off value > 0.85 (mg/dl) with Sensitivity 73% and Specificity 71%.
Our study showed that the cumulative overall survival of patients according to the presence or absence of HCC recurrence:
i. The mean time to death (survival time) of the studied patients without HCC recurrence after liver transplantation was 9 years with 95% confidence interval (8 – 10) years
ii. The mean time to death (survival time) of the studied patients with HCC recurrence after liver transplantation was 2.5 years with 95% confidence interval (1 – 4) years
So the relation between HCC recurrence and outcome post LT showed that HCC recurrence significantly affects the outcome of patients undergoing LT (p < 0.001).
Regarding mean time to HCC recurrence post LT, the current study showed that it was 2 years with 95% confidence interval (1 – 3) years.
Finally our study focused on the potential utility of the inflammatory markers as a simple, non invasive prognostic markers, in addition to the standard parameters to refine recipient selection to reduce the incidence of TR and improve survival post LT.
CONCLUSION
The rate of HCC recurrence post liver transplantation during the 10 years follow up was 11 (11%) out of 100 cases (100%).
Pre-transplant AFP can predict HCC recurrence with best cut off value > 17.8 ng/ml with Sensitivity 82% and Specificity 70%.
Post-transplant CRP can predict HCC recurrence with best cut off value > 0.85 (mg/dl) with Sensitivity 73% and Specificity 71%.
The mean time to HCC recurrence after liver transplantation was 2 years with 95% confidence interval.
The mean time to death (survival time) of HCC patients without recurrence after liver transplantation was 9 years with 95% confidence interval while those with recurrence the survival time was 2.5 years with 95% confidence interval.
HCC recurrence significantly affects the outcome of patients undergoing LT (p < 0.001). Therefore the prognosis of patients with HCC recurrence following LT remained very poor.
RECOMMENDATIONS
Inflammatory indices can be used in addition to the standard parameters as a simple, non invasive prognostic markers to refine recipient selection to reduce the incidence of tumor recurrence and improve survival post Liver transplantation.
Screening with pre-LT AFP > 17.8 ng/ml and post LT CRP > 0.85 mg/dl increase the predictive value for the presence of postoperative HCC recurrence, so patients should be strictly and regularly screened.
Close monitoring intervals for HCC patients post LT especially the first 2 years for early detection, also allowing curative treatment options and therefore may improve the outcome of these patients.
Further future studies on larger number of patients are needed to correlate CRP, PLR, NLR pre and post intervention and HCC recurrence post Liver transplantation.