Abstract
Ninety-three patients with malignant disease underwent orthotopic liver transplantation between May 1968 and April 1987 in the Cambridge/King's College Hospital program. Of 50 patients with primary hepatocellular carcinoma (HCC) (19 with cirrhosis, 31 without cirrhosis, including 7 with fibrolamellar variant), 37 (74%) survived for more than 3 months, and in this group evidence of tumor recurrence was obtained in 24 (64.9%), the longest survivor being 11.8 years post-transplant, and three survived for more than 5 years. Although there is no correlation between the frequency of tumor recurrence and underlying cirrhosis, or histologic type (except fibrolamellar variant), it was observed earlier in those with moderate/poorly differentiated tumors and also when prednisolone and azathioprine was used for immunosuppression. Tumor recurred in all but two of those with peripheral or central cholangiocarcinoma (one alive at 6.1 years) with median survival times of 34 weeks and 56 weeks for the central and peripheral types, respectively. Among the unusual primary tumors, one with epithelioid haemangioendothelioma developed tumor recurrence at 2 years, one of two patients with apudoma is tumor-free at 2.2 years, and the one patient with bile-duct papillary cystadenocarcinoma is alive at 1.7 years. For the secondary hepatic malignancy group, survival times were shorter with little palliation except for two patients with carcinoid syndrome who were free of associated symptoms at 6 and 10 months. Despite the overall high frequency of tumor recurrence in most categories of hepatic malignancy, liver transplantation gave worthwhile survival with a number of patients cured and in the others considerable palliation of symptoms.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blumgart L. H., Hadjis N. S., Benjamin I. S., Beazley R. Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet. 1984 Jan 14;1(8368):66–70. doi: 10.1016/s0140-6736(84)90002-3. [DOI] [PubMed] [Google Scholar]
- Colonna J. O., 2nd, Ray R. A., Goldstein L. I., Hiatt J. R., Quinones-Baldrich W., Ramming K. P., Busuttil R. W. Orthotopic liver transplantation for hepatobiliary malignancy. Report of three cases of special interest. Transplantation. 1986 Nov;42(5):561–562. doi: 10.1097/00007890-198611000-00025. [DOI] [PubMed] [Google Scholar]
- Iwatsuki S., Gordon R. D., Shaw B. W., Jr, Starzl T. E. Role of liver transplantation in cancer therapy. Ann Surg. 1985 Oct;202(4):401–407. doi: 10.1097/00000658-198510000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson P. J., Williams R. Serum alpha-fetoprotein estimations and doubling time in hepatocellular carcinoma: influence of therapy and possible value in early detection. J Natl Cancer Inst. 1980 Jun;64(6):1329–1332. doi: 10.1093/jnci/64.6.1329. [DOI] [PubMed] [Google Scholar]
- Mittal R., Kowal C., Starzl T., Van Thiel D., Bron K., Iwatsuki S., Schade R., Straub W., Dekker A. Accuracy of computerized tomography in determining hepatic tumor size in patients receiving liver transplantation or resection. J Clin Oncol. 1984 Jun;2(6):637–642. doi: 10.1200/JCO.1984.2.6.637. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mühlbacher F., Piza F. Orthotopic liver transplantation for secondary malignancies of the liver. Transplant Proc. 1987 Feb;19(1 Pt 3):2396–2398. [PubMed] [Google Scholar]
- Pichlmayr R., Brölsch C., Wonigeit K., Neuhaus P., Siegismund S., Schmidt F. W., Burdelski M. Experiences with liver transplantation in Hannover. Hepatology. 1984 Jan-Feb;4(1 Suppl):56S–60S. doi: 10.1002/hep.1840040716. [DOI] [PubMed] [Google Scholar]
- Starzl T. E., Iwatsuki S., Shaw B. W., Jr, Nalesnik M. A., Farhi D. C., Van Thiel D. H. Treatment of fibrolamellar hepatoma with partial or total hepatectomy and transplantation of the liver. Surg Gynecol Obstet. 1986 Feb;162(2):145–148. [PMC free article] [PubMed] [Google Scholar]
- Søreide O., Czerniak A., Blumgart L. H. Large hepatocellular cancers: hepatic resection or liver transplantation? Br Med J (Clin Res Ed) 1985 Sep 28;291(6499):853–857. doi: 10.1136/bmj.291.6499.853. [DOI] [PMC free article] [PubMed] [Google Scholar]