EXTENDING THE TUMOUR SIZE IMPAIRS THE OUTCOME AFTER LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA

P555 Aims: Orthotopic liver transplantation (OLT) offers the treatment of choice for patients with unresectable hepatocellular carcinomas (HCC), but the scarcity of organ donors limits the availability of this therapy. Many centers apply the Milan Criteria (tumour size ≤5 cm for a solitary nodule or ≤3 cm in case of 3 nodules) to select patients who will benefit from OLT. However, there is a recent tendency to expand tumour sizes qualifying for OLT. The purpose of the present study is to reconsider tumour size and histopathological features as selection criteria for OLT. Methods: Retrospective analysis of prospectively collected data on 93 adult HCC patients who underwent OLT between June 1985 and December 2003 at our institution. Median follow-up was 28 months (1-222 months). 76 patients had preoperatively known HCC and in 17 cases a HCC was diagnosed incidentally on the explanted liver. Study period were arbitrarily divided into two time intervals: 1985 to 1993 and 1994 to 2003. Results: Overall 5 year survival rate of HCC patients was significantly lower than in patients transplanted for benign diseases, 41% and 71% respectively (p < 0.0001). Survival after OLT revealed a significant dependency on tumour size (p < 0.005), number of nodules had only a minor effect on survival (p = 0.72). The overall survival rate for HCC which met the Milan criteria was 60% at 5 years (p < 0.01) and even improved since 1994 to 70% compared to 76% of patients after OLT for benign diseases. Tumour cell differentiation (G1 vs. G2 and G3, p < 0.05) and vascular invasion (p < 0.001) also were significant predictors of survival. Conclusions: Applying the Milan criteria for patients with HCC is still a valuable predictor of outcome after transplantation, because expanding the tumour size obviously has a negative impact on the survival rates after OLT for HCC.