Resultados do transplante hepático em pacientes com diagnóstico pré-operatório de hepatocarcinoma

Abstract

Background - Hepatocellular carcinoma is the most frequent malignant hepatic tumor in humans, and its association with cirrhosis makes the therapeutic approach still a challenge. Liver transplantation is the treatment of choice for cirrhotic patients with unresectable early hepatocellular carcinoma. Aim - To evaluate the post-transplant outcome of a cohort of 15 cirrhotic patients with preoperative diagnosis of unresectable early hepatocellular carcinoma according the Milan criteria who underwent liver transplantation between September 1991 and December 2003. Methods - We retrospectively reviewed the clinical data from 15 liver transplant recipients and the explanted livers were assessed for the efficacy of preoperative therapy. Patient survival and tumor recurrence were evaluated as primary outcome measures. Results - The mean age of the patients was 49.2 ± 14.3 years and hepatitis C was the etiology of the underlying liver disease in 60%. Preoperative therapy, either chemoembolization or percutaneous ethanol injection, was performed in 12 (86%) patients. Complete necrosis of all tumoral lesions were observed in 5 of 12 patients (44,66%); all others had variable amounts of viable tumor in the explanted liver. Only 4 of the 15 (26.6%) explanted livers had microscopic vascular invasion. The median post-transplant follow-up was 33 months (range: 8-71months) and no tumor recurrence was detected during this period. The only death was an early event not related to the tumor. The recurrence-free survival rates at 1 and 3 years were 93%. Conclusion - Liver transplantation has emerged as a good alternative for cirrhotic patients with early hepatocellular carcinoma not amenable to curative resection, offering excellent recurrence-free survival rates.