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Abstract Details
Impact of clinically evident portal hypertension on the course of hepatocellular carcinoma in patients listed for liver transplantation
Faitot F1, Allard MA, Pittau G, Ciacio O, Adam R, Castaing D, Sa Cunha A, Pelletier G, Cherqui D, Samuel D, Vibert E. Hepatology. 2015 Apr 24. doi: 10.1002/hep.27864. [Epub ahead of print]
Author information
1AH-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Abstract
Liver transplantation (LT) is the best curative treatment for early HCC in cirrhotic patients. However, the current shortage of organs causes prolonged waiting times and poorer intention to treat survival (i.e. after listing) due to tumor progression and drop out. Portal hypertension (PHT) is a recognized risk factor of HCC development in cirrhotic patients and its recurrence after resection. The aim of this study was to evaluate the potential impact of PHT on the results of liver transplantation on an intent-to-treat basis. Cirrhotic patients listed for LT for HCC were included and their outcomes after listing were compared according to the presence or absence of portal hypertension defined as presence of esophageal varices or ascites or low platelet count and splenomegaly. Among 243 consecutively listed patients, 70% were affected by PHT which was associated with a significantly higher risk of tumor progression (38% vs 22%; p=0.017) and a higher risk of drop out (22% vs 8%; p=0.01). Transarterial chemoembolization (TACE) was similarly applied to the 2 groups (60 vs 67%; p=0.325). An absence of TACE was the only other independent risk factor of drop out due to tumor progression. Under an intention-to-treat analysis, PHT reduced overall survival, but there was no difference in overall survival and time to recurrence after LT. The only pathological feature that could potentially explain this observation was the lower complete response to TACE in the PHT group (12% vs 36%; p=0.001). PHT should therefore be regarded as a major risk factor of drop out due to tumor progression and should be taken in consideration when managing patients with HCC who are waiting for LT.