Liver transplantation for hepatocellular carcinoma among African Americans in the United States

There is increased prevalence of hepatocellular carcinoma [HCC] among African Americans [AA]. Multicenter studies have shown advanced presentation, underutilization of treatment and decreased survival following liver transplantation [LT] among AA. However outcomes from single centers are not well reported. To determine the outcome of AA undergoing LT for HCC at Cleveland Clinic, Cleveland, Ohio, between May 2007 and December 2009. 245 consecutive patients undergoing evaluation and treatment for HCC within the mentioned time frame were studied, retrospectively. 80% of patients were male, 75.5% were Caucasian, 16.7% were AA and 7.8% were other ethnic groups. Compared to other ethnicities, AA subjects with HCC were more commonly female and were more likely to have hepatitis C virus [HCV] [83% vs. 51%, p<0.001]. There were higher occurrence of HCV genotype 1 among AA compared to others among patients with this information [100% vs. 65%, p<0.001]. In contrast to previous reports, there was no significant difference between the groups in terms of clinical presentation or management. 27% of AA underwent liver transplantation compared to 28% of the rest [p=0.88]. Of the 68 patients who had LT, 9% died with no difference in post-LT survival between the two groups. HCV [and genotype 1] is a significant risk factor for HCC in the AA population. LT results in similar survival compared to other ethnicities. AA patients with HCC benefit equally from LT compared to other ethnicities

Serum vascular endothelial growth factor level in patients with hepatocellular carcinoma undergoing liver transplantation: experience of a single western center

The strongest predictor of tumor relapse after liver transplantation for hepatocellular carcinoma [HCC] is vascular invasion, appreciated only on explant analysis. High serum level of vascular endothelial growth factor [VEGF] is associated with worse outcomes after resection or locoregional therapies but its role in liver transplantation remains undefined. We report the first western prospective study exploring serum VEGF in HCC liver transplant patients, correlating pre-operative serum VEGF with poor prognostic histologic features during explant analysis. Between May 2008, and June 2010, 75 HCC patients underwent liver transplantation at our institution. Serum VEGF was measured every 3 months until liver transplantation and correlated with histopathologic findings on explant. There was no significant correlation between pre-transplant serum VEGF levels and tumor burden [median 31.0 pg/mL vs. 42.5 pg/mL, p=0.33, for tumors within and beyond the Milan criteria, respectively]. Pre-transplant VEGF levels were higher in poorly differentiated tumors compared to well to moderately differentiated tumors, but not statistically significant [median 49.0 pg/mL vs. 31.0 pg/mL, p=0.26]. Pre-transplant VEGF did not correlate with vascular invasion [median 37.0 pg/mL vs. 31.0 pg/ mL, p=0.35, in the presence and absence of vascular invasion, respectively]. Pre-operative serum VEGF fails to predict unfavorable histologic HCC features in patients undergoing liver transplantation. Role of serum VEGF in liver transplant HCC patients remains unclear