Liver transplantation for hepatocellular carcinoma in Ireland: Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience

doi:10.5500/wjt.v6.i2.396

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World Journal of Transplantation

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World J Transplant. Jun 24, 2016; 6(2): 396-402
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.396

Liver transplantation for hepatocellular carcinoma in Ireland: Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience

Donal B O’Connor, John P Burke, John Hegarty, Aiden P McCormick, Niamh Nolan, Emir Hoti, Donal Maguire, Justin Geoghegan, Oscar Traynor

Donal B O’Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland

Donal B O’Connor, John P Burke, Departments of Hepatobiliary Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

John Hegarty, Aiden P McCormick, Emir Hoti, Donal Maguire, Justin Geoghegan, Oscar Traynor, National Liver Transplant Programme, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

Niamh Nolan, Departments of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

Author contributions: O’Connor DB and Traynor O conceived project; O’Connor DB contributed to the preparation of manuscript and data acquisition; Burke JP contributed to statistical analysis and critical revision of manuscript; Nolan N contributed to analysis of histopathology; Hegarty J, McCormick AP, Hoti E, Maguire D, Geoghegan J and Traynor O contributed to critical revision of manuscript.

Institutional review board statement: The study was approved by the St Vincent’s University Hospital ethics review board.

Informed consent statement: Informed consent was not required for this study.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Data sharing statement: No additional data.

Correspondence to: Donal B O’Connor, Lecturer in Surgery, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Room 1.36, Dublin 24, Ireland. oconnd15@tcd.ie

Telephone: +353-1-4142218 Fax: +353-1-4142212

Received: November 11, 2015
Peer-review started: November 15, 2015
First decision: January 4, 2016
Revised: April 12, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: June 24, 2016
Processing time: 223 Days and 16.6 Hours

Abstract

AIM: To examine the results of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) in Ireland over a 14-year period.

METHODS: Cases of HCC receiving OLT between January 1995 and September 2009 in the Irish Liver Transplant Unit were reviewed from a prospectively maintained database. Outcome measures included overall and recurrence free survival, alpha-fetoprotein (AFP) and tumour pathological features.

RESULTS: On explant pathology, 57 patients had HCC. The median follow-up time was 42.7 mo. The overall 1, 3 and 5 years survival was 87.7%, 72.1% and 72.4%. There was no difference in survival when compared to patients undergoing OLT without malignancy. The tumour recurrence rate was 14%. The Milan criteria were exceeded in 32% of cases but this did not predict overall survival or recurrence. On multivariate analysis pre-operative AFP > 100 ng/mL was an independent risk factor for recurrence (RR = 5.2, CI: 1.1-24.3, P = 0.036).

CONCLUSION: Patients undergoing OLT for HCC had excellent survival even when conventional listing criteria were exceeded. Pre-operative AFP predicts recurrence independent of tumour size and its role in selection criteria should be investigated in larger studies.

Keywords: Liver transplantation; Alpha-fetoprotein; Hepatocellular carcinoma; Transplantation selection criteria; Liver cirrhosis

Core tip: We have shown good survival from a medium volume transplant centre in a small cohort of patients exceeding Milan criteria. We show an association between a pre-operative alpha-fetoprotein (AFP) > 100 and hepatocellular carcinoma (HCC) recurrence, independent of tumour size. Our study supports other single centre experience on survival after transplant for HCC with low AFP and indicates that AFP needs to be interrogated in large, multi-centre studies to see if it can be included in transplant listing criteria to augment the current radiology based dimensional criteria.