الفهرس 
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Abstract
H
epatocellular carcinoma (HCC) is one of the most common malignancies worldwide, accounting for about 1 million related deaths annually.The incidence of HCC is highest in Asia and Africa, where the endemic high prevalence of hepatitis B and hepatitis C strongly predisposes to the development of chronic liver disease and subsequent development of HCC.
LT should be considered in patients with end-stage liver disease, in whom the LT is expected to extend life expectancy beyond what the natural history of underlying liver disease would predict or in whom LT is expected to improve the quality of life (QoL). Patients should be selected if expected survival in the absence of transplantation is one year or less, or if the patient had an unacceptable QoL because of liver disease.
Liver transplantation in HCC patients currently represents 20-30% of the indications for liver transplantation in United States of America (USA) and Europe. While in Egypt represents 26% of the indications for liver transplantation.
A total number of 315 patients underwent LDLT at ASCOT during the period from 2008 till January 2019,out of which 114 patients underwent LDLT due to HCV related hepatocellular carcinoma.
Fourteen patients(12.2%) were excluded because of the intraoperative death or postoperative early death, 7 patients(6%) were excluded because of overlapping etiologies with hepatitis C (HBV,autoimmune hepatitis,BCS,…etc) and 11 patients (9.6%) were excluded due to their age.
In the present study, there was no statistical significance between the type of immunosuppressive therapy and the 5 year survival and the main post LDLT complications(which are mortality, HCC recurrence , rejection , biliary coplications and vascular complications) except for HCC recurrence and rejection.
There was statistical significance between certican stoppage and the occurrence of recurrent HCC post-transplant.
Fifteen patients received certican (mTOR inhibitors) as immunosuppressive therapy post transplantation, 5 of them had stopped it and then developed HCC recurrence while the other 10 patients who hadn’t stopped it didn’t develop HCC recurrence.
There was no statistical significance for those within or out side the Milan criteria or UCSF criteria and its impact on the occurrence of graft rejection, sepsis, vascular complications and biliary complications post-transplant.
In our study, the 1 year, 2 years, 3 years and 5 years survival rate was 92 %, 90.7%, 87.4% and 87% respectively.There was statistical significance regarding the serum bilirubin, serum albumin and serum INR at 1 month and its impact on the 5-year survival post-transplant with P-value 0.015, 0.015 and 0.003 respectively.The survivors had higher serum albumin with median 3.2, lower serum bilirubin with median 0.9 and lower serum INR with median 1.04.
We found that there was no statistical significance between the DM and survival.
This study showed that there was no statistical significance between the preoperative child score (A,B,C) and the survival of the HCC patients postoperative.
The cumultive incidence of mortality in our study was 4.9% ( 4 patients) after 3 months, 6.2% (5 patients) after 6 months , 7.6% (6 patients) after 1 year, 12.6% (9 patients) after 3 years and 12.6% (9 patients) after 5 years postoperative.
The sensitivity of serum bilirubin, serum albumin and serum INR for prediction of 5-year mortality was 78%, 56% and 78% respectively while the specificity was 68%, 86% and 78% respectively with serum INR having best predictive value.Patients with serum bilirubin >1.3 mg/dl, serum albumin ≤2.5 g/dl and serum INR >1.1 had high prediction of 5 year mortality.
Results in this study suggest that there was no statistical significance regarding the Milan criteria& UCSF criteria and its impact on the occurrence of mortality post-transplant.
In this study 10 patients suffered from the recurrence of HCC representing 12 % of all patients.The cumultive incidence of HCC recurrence was zero (no patients) after 3 months, zero (no patients) after 6 months, 0.015(one patient) after 1 year, 0.139(8 patients) after 3 years and 0.168(10 patients) after 5 years.Nine patients within Milan criteria and one patient was beyond, all the 10 patients were within UCSF criteria.
There was no statistical significance between down staging& bridging pretransplantation and HCC recurrence post transplantation.
Results in the present study suggested that there was very high statistical significance between the size of HFL and HCC recurrence after liver transplantation.The larger the size of HFL,the more risk of developing HCC recurrence. There was also statistical significance between microvascular invasion and HCC recurrence. Microvascular invasion was found in the explant of 10 patients, 4 of them developed HCC recurrence.We found that there is high statistical significance between hepatic focal lesion differentiation and HCC recurrence after liver transplantation. Sixteen patients(19.5%) had well differentiated hepatic focal lesions,no one of them developed HCC recurrence.Fifty two patients (63.4%) had moderately differentiated hepatic focal lesions, 8 patients developed HCC recurrence.While all patients(2 patients) which had poorly differentiated hepatic focal lesions developed HCC recurrence.
In the current study, There was no statistical significance between the child score (A,B,C) and HCC recurrence .There was no statistical significance regarding the serum bilirubin, serum albumin, serum INR, serum AST &ALT at 1 month and its impact on the occurrence of HCC recurrence post-transplant.
In this study we found that there was no statistical significance between HCC recurrence and Preoperative AFP Level.However, there was high statistical significance between HCC recurrence and postoperative AFP Level with P-value 0.001.