Outcomes of liver transplantation in hepatocellular carcinoma: a single-center experience
Aim. To evaluate the long-term results of liver transplantation for hepatocellular carcinoma. To perform an analysis of risk factors for tumor recurrence. Materials and methods. A retrospective analysis of 63 deceased donor liver transplantations, which were performed from January 2010 to February 2020. Patients were divided into three groups according to the Milan and California criteria - within the Milan criteria, outside the Milan criteria, but within the California criteria, outside the California criteria. Results. There were 33 recipients within the Milan criteria, 5 within the California criteria, and 25 outside the California criteria. The 5-years recurrence rate was 9.1%, 40% and 52%, respectively (p = 0.002), five-year survival rate of - 93.2%, 66.7% and 54.7% (p = 0.041). Factors associated with an increased risk of recurrence: five and more tumor nodes (OR = 3.675; 95% CI (1.35-9.97); p = 0.011), macroscopic vascular invasion (OR = 5.97; 95% CI (2.06-17.31); p = 0.001) and inconsistency with California criteria (OR = 4.00; 95% CI (1.49-10.74); p = 0.006). The factors associated with a lower recurrence rate: one or two tumor nodes (p = 0.014 and 0.042, respectively), a high grade of histological differentiation (RR = 0.24; 95% CI (0.06-0.93); p = 0.039), compliance with Milanese criteria (RR = 0.18; 95% CI (0.06-0.58); p = 0.004). Conclusion. Liver transplantation can be performed in a number of patients beyond the Milan and California criteria. The morphological and biological characteristics of the tumor and a multidisciplinary differentiated approach to treatment have an important role in the success of treatment.