الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Hepatocellular carcinoma (HCC) ranks as the fifth most common cancer
in the world with an increasing incidence, and represents the third most
common cause of death from cancer worldwide. HCC is accounting for
٨٥٪ of primary liver cancer, and cirrhosis due to viral hepatitis infection
is the leading cause. The final diagnosis of HCC is increasingly based on
imaging criteria in contrast enhanced studies according to recent EASL
and AASLD guidelines. And these criteria are based exclusively on the
vascular findings of HCC.
The rational of treatment of HCC is to remove the malignancy while
preserving liver function. So LT is the best curative treatment for HCC,
because it removes the tumor with the widest margin together with any
intra-hepatic metastasis. Also, it cures the underlying cirrhosis that is
responsible for metachronous neoplasm and it helps in the histologic
examination of the entire liver explants for the most accurate pathologic
staging. Recently, improvement in the outcome of liver transplantation
for HCC is attributed almost entirely to better patient selection, rather
than better surgery or adjuvant therapy. LDLT is emerged as treatment
modality to increase donor pool and decrease waiting time for transplant.
The aim of this study is to analyze risk factors and different causes of
mortality in patients underwent LDLT for HCC based on evaluation of
variable pre-operative diagnostic modalities, staging systems, operative
data, pathological studies, and post-operative outcome in cases done in the National Liver Institute, Menoufiya University between April ٢٠٠٣
and the end of December ٢٠١٣.
In this study, ٦١ patients underwent LRLT for hepatic focal lesions, ٥٣
ones had HCC confirmed by post-operative pathological studies. In this
series, ٥٠ males (٩٤ ٣٪) and ٣ females (٥ ٧٪) with the mean age of ٤٨
years (ranging from ٣٦-٦٠) and ٢٢ cases of them were transplanted a
graft from ١st degree relative. Of ٥٣ patients, HCV positive patients were
٥٢ (٩٨٪) and only one patient (٢٪) was HBV positive.
The majority of patients ٧٣٪ (٣٩ patients) had good performance status
grade (٠) based on WHO classification. According to Child score, only ٨
recipients (١٥٪) had Child A, but the majority of patients were Child B
and C, ٢٥ (٤٧٪) and ٢٠ (٣٧ ٧٪) respectively. Also, patients had mean
MELD score of ١٤ ٢. The mean AFP level was ٣٢٤ ng/ml, but the
majority of patients ٥٢ ٨٪ (٢٨ patients) had normal levels below ٢٠
ng/ml.
In this study, the standard of diagnostic modalities of HCC was combined
radiological modality (US and triphasic CT). The sensitivity of
radiological work up in our work was ٨٦٪ and specificity was nearly
١٠٠٪ for HFL more than ١ cm. In comparison with pathological study in
this study, there was overestimation of patients with HCC by using
radiological work up by ١٤٪. In this study, twenty six patients underwent
PET/ CT study as a workup modality for HCC, but only seventeen
patients had a detectable HFL. So, the sensitivity of PET scan was ٦٥٪ in
detecting HCC.
In this study, ١٩ patients (٣٥ ٨٪) had undergone bridging treatment.
TACE and RFA were the most common bridging therapies and were
done in eight (١٥ ١٪) for each, combined RFA and TACE was applied
for only ٢ patients and only one patient (١ ٩٪) had alcohol injection. But
only ٤ patients had effective ablative therapy (a well ablated tumor
mainly reported with RFA) before transplant in pathological study of the
explanted liver.
According to this study, there was no big variation between radiological
and pathological Milan. So, radiological studies were good in selection of
candidates for liver transplantation by using Milan criteria. In this study,
radiological assessment of patients within UCSF was more than definite
pathological assessment, so there was overestimation by ٦٪.
There were many staging systems for HCC. In this series, we used ٤
different staging systems as Okuda, CLIP, BCLC and TNM staging
systems. According to Okuda, the majority of recipients ٤٠ (٧٥ ٥٪) were
in stage II. In CLIP staging system, ٤٦ patients (٨٦ ٨ %) are in early
stages (stage ١, ٢ and ٣). Also, the majority of patients ٤١٪ (٢٢ patients)
were in stage D according to BCLC. In addition, TNM staging system
(radiological based) showed that most common patients ٣٤ (٦٤٪) were in
stages I and II.
In this study, post operative pathological assessment underwent for all
surgical specimens. In pathological study, macro-vascular invasion was
absent in the majority of patients ٩٦٪ (٥١ patients), and also microvascular
invasion was detected only in ١٢ patients (٢٢٪).