Liver transplantation for fibrolamellar hepatocellular carcinoma: A national perspective

J Surg Oncol. 2017 Mar;115(3):319-323. doi: 10.1002/jso.24515. Epub 2016 Nov 23.

Abstract

Background: Fibrolamellar Hepatocellular Carcinoma (FL-HCC) is a rare primary liver tumor that usually presents in younger patients without underlying liver disease.

Methods: We queried the United Network of Organ Sharing (UNOS) database between October 1988 and January 2013 to evaluate outcomes in patients with FL-HCC undergoing liver transplantation in the United States compared to patients with conventional Hepatocellular Carcinoma (HCC).

Results: Sixty-three patients were identified (57% female, mean age 30 years). Only one patient (2%) had an associated Hepatitis C Virus. Mean Model for End-Stage Liver Disease (MELD) score at the time of transplantation was 11.3. Mean waiting time was 325 days and mean cold ischemic time was 6 hr. Overall survival of FL-HCC patients at 1, 3, and 5 years was 96%, 80%, and 48% as compared to HCC patients whose rates were 89%, 77%, and 68%. Six patients had tumor recurrence (10%). The Cox Model demonstrated that MELD and cold ischemic time are the strongest predictors of overall survival in FL-HCC patients. Age and wait time were not associated with poor patient survival in this series.

Conclusions: Good results can be obtained in selected patients transplanted for FL-HCC. FL-HCC patients had similar survival compared to those transplanted for HCC. J. Surg. Oncol. 2017;115:319-323. © 2016 Wiley Periodicals, Inc.

Keywords: fibrolamellar; fibrolamellar hepatocellular carcinoma; liver transplantation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / surgery*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / surgery*
  • Liver Transplantation / methods
  • Liver Transplantation / statistics & numerical data*
  • Male
  • Middle Aged
  • United States / epidemiology
  • Young Adult