Hepatic transplantation for primary and metastatic cancers of the liver

TitleHepatic transplantation for primary and metastatic cancers of the liver
Publication TypeJournal Article
Year of Publication1991
AuthorsPenn I
Pagination726 - 34; - discussion - 734-5
Date PublishedOct
Accession Number1656538
Keywords*Liver Transplantation, Adenoma, Bile Duct / secondary / *surgery, Adolescent, Adult, Aged, Carcinoma, Hepatocellular / secondary / *surgery, Child, Child, Preschool, Female, Hemangiosarcoma / secondary / *surgery, Humans, Infant, Liver Neoplasms / secondary / *surgery, Male, Middle Aged, Neoplasms, Unknown Primary, Research Support, U.S. Gov't, Non-P.H.S.

Long-term results of transplantation for primary and metastatic hepatic malignancies were evaluated retrospectively in 637 patients. Recurrence rates and 2-year and 5-year patient survival rates were calculated. The overall recurrence rate was 40%, with 81% of deaths from recurrence occurring within 2 years after transplantation. Best results were obtained with uncommon tumors: incidental hepatomas (13% recurrence; 57% 2-year and 5-year follow-up); epithelioid hemangioendotheliomas (33% recurrence; 82% and 43% 2-year and 5-year survival); hepatoblastomas (33% recurrence; 50% 2-year and 5-year survival); and fibrolamellar hepatomas (39% recurrence; 60% and 55% 2-year and 5-year survival). Hemangiosarcomas had 64% recurrence, and all patients died within 27.5 months. Tumors metastatic to the liver had 59% recurrence, with 38% and 21% 2-year and 5-year survival rates. Transplantation should be abandoned for hemangiosarcomas and most metastatic tumors, except possibly for some slowly growing neuroendocrine tumors. The usual hepatomas had 39% recurrence with 2-year and 5-year survival rates of 30% and 18%, respectively. Cholangiocarcinomas had 44% recurrences with 2-year and 5-year survival rates of 30% and 17%, respectively. Transplantation for hepatomas and cholangiocarcinomas should be reserved for patients with favorable risk factors or when combined with well-defined chemotherapy protocols before and after operation.

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