Liver Transplantation for Hepatocellular Carcinoma: Impact of Wait Time at a Single Center

ABSTRACT Introduction and aim. Liver transplantation (LT) provides durable survival for hepatocellular carcinoma (HCC). However, there is continuing debate concerning the impact of wait time and acceptable tumor burden on outcomes after LT. We sought to review outcomes of LT for HCC at a single, large U.S. center, examining the influence of wait time on post-LT outcomes. Material and methods. We reviewed LT for HCC at Mayo Clinic in Florida from 1/1/2003 until 6/30/2014. Follow up was updated through 8/1/ 2015. Results. From 2003-2014,978 patients were referred for management of HCC. 376 patients were transplanted for presumed HCC within Milan criteria, and the results of these 376 cases were analyzed. The median diagnosis to LT time was 183 days (8 - 4,337), and median transplant list wait time was 62 days (0 -1815). There was no statistical difference in recurrence-free or overall survival for those with wait time of less than or greater than 180 days from diagnosis of HCC to LT. The most important predictor of long term survival after LT was HCC recurrence (HR: 18.61, p < 0.001). Recurrences of HCC as well as survival were predicted by factors related to tumor biology, including histopathological grade, vascular invasion, and pre-LT serum alpha-fetoprotein levels. Disease recurrence occurred in 13%. The overall 5-year patient survival was 65.8%, while the probability of 5-year recurrence-free survival was 62.2%. Conclusions. In this large, single-center experience with long-term data, factors of tumor biology, but not a longer wait time, were associated with recurrence-free and overall survival.

Experience on endoscopic retrograde cholangiopancreatography at tertiary referral center in Thailand: risks and complications.

BACKGROUND: Several complications from ERCP have been described, including pancreatitis, hemorrhage, perforation, and cholangitis. The actual incidences and risk factors in Thailand have never been analyzed. MATERIAL AND METHOD: The authors retrospectively reviewed the outcome of ERCP at Chulalongkorn University Hospital between September 2000 and December 2002. Potential risk factors were statistically assessed. RESULTS: The incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 3.6%, 2.1%, 1.2% and 6%, respectively. Risk factors of pancreatitis were the suspected diagnosis of sphincter of Oddi dysfunction and pancreatic interventions, especially through minor papilla. Prophylactic pancreatic duct stent prior to precut sphincterotomy may reduce the incidence of pancreatitis. Hemorrhage was associated with duodenal diverticulum. The incidence of cholangitis was higher in biliary duct dilation and cholangiocarcinoma, especially hilar involvement. CONCLUSION: Incidence of these complications was comparable to international series with similar risk factors. Cholangitis developed more frequently probably due to a higher incidence of cholangiocarcinoma.