Liver transplantation for hepatocellular carcinoma: differences in pre-transplant radiology versus explant pathology and impact on survival.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-02-20 DOI:10.1016/j.hpb.2025.02.009

Diana A Wu, James Vassallo, Calum Worsley, Chris Bellamy, Jim Gordon-Smith, Anya Adair

{"title":"Liver transplantation for hepatocellular carcinoma: differences in pre-transplant radiology versus explant pathology and impact on survival.","authors":"Diana A Wu, James Vassallo, Calum Worsley, Chris Bellamy, Jim Gordon-Smith, Anya Adair","doi":"10.1016/j.hpb.2025.02.009","DOIUrl":null,"url":null,"abstract":"Background: Suitability for liver transplantation in patients with hepatocellular carcinoma (HCC) is based on Milan imaging criteria developed several decades ago. We sought to compare pre-transplant imaging with explant liver histopathology in a national retrospective observational study.Methods: All patients who underwent liver transplantation for HCC at the Scottish Liver Transplant Unit (2015-2020) were included. Per-lesion sensitivity of imaging, proportion of patients transplanted outwith UK transplant criteria and two-year survival outcomes were analysed.Results: 140 patients were included. Per-lesion sensitivity was 70 % (38 % for lesions <10 mm). Histopathology of 36 (26 %) patients were outwith UK transplant criteria. 19 (14 %) livers contained >5 HCCs, median lesion size was 9 mm. 9 (6 %) livers contained cholangiocarcinoma. Two-year survival rates: cholangiocarcinoma 100 %, combined HCC-cholangiocarcinoma 100 %, HCC within criteria 90.8 %, HCC outwith criteria 87.5 %, >5 HCCs 77.8 % (p = 0.010).Conclusion: Current pre-operative imaging for liver transplantation has suboptimal sensitivity, particularly for sub-centimetre lesions. A quarter of transplanted patients are subsequently found to be outwith transplant criteria on explant histopathology, but most have good short-term survival (including cholangiocarcinoma), except for patients with multi-focal small HCCs. Further research is needed to better identify this cohort and to explore whether transplant criteria should be revised.","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hpb","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hpb.2025.02.009","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Suitability for liver transplantation in patients with hepatocellular carcinoma (HCC) is based on Milan imaging criteria developed several decades ago. We sought to compare pre-transplant imaging with explant liver histopathology in a national retrospective observational study.

Methods: All patients who underwent liver transplantation for HCC at the Scottish Liver Transplant Unit (2015-2020) were included. Per-lesion sensitivity of imaging, proportion of patients transplanted outwith UK transplant criteria and two-year survival outcomes were analysed.

Results: 140 patients were included. Per-lesion sensitivity was 70 % (38 % for lesions <10 mm). Histopathology of 36 (26 %) patients were outwith UK transplant criteria. 19 (14 %) livers contained >5 HCCs, median lesion size was 9 mm. 9 (6 %) livers contained cholangiocarcinoma. Two-year survival rates: cholangiocarcinoma 100 %, combined HCC-cholangiocarcinoma 100 %, HCC within criteria 90.8 %, HCC outwith criteria 87.5 %, >5 HCCs 77.8 % (p = 0.010).

Conclusion: Current pre-operative imaging for liver transplantation has suboptimal sensitivity, particularly for sub-centimetre lesions. A quarter of transplanted patients are subsequently found to be outwith transplant criteria on explant histopathology, but most have good short-term survival (including cholangiocarcinoma), except for patients with multi-focal small HCCs. Further research is needed to better identify this cohort and to explore whether transplant criteria should be revised.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).