Outcome of Living-Donor Liver Transplant for Hepatocellular Carcinoma: 15-Year Single-Center Experience in Egypt.

OBJECTIVES: Liver transplant performed for hepatocellular carcinoma must adhere to criteria for the size and number of focal hepatic lesions to lower the incidence of recurrence and achieve survival rates comparable to patients transplanted for other indications. Since the Milan criteria were established in 1996, there have been many less restrictive criteria yielding similar results. Our aim was to identify the prognostic factors for patient survival and for recurrence of hepatocellular carcinoma for patients within and beyond the Milan criteria. MATERIALS AND METHODS: This retrospective and prospective analysis was conducted in 60 adult patients who underwent right lobe living-donor liver transplant for cirrhosis complicated by hepatocellular carcinoma at Dar Al Fouad Hospital, 6th of October City, Egypt, between August 2001 and June 2012. The median follow-up was 39.5 months. RESULTS: Overall 1-, 3-, and 5-year survival rates were 98.3%, 93.5%, and 71.4%. Overall disease-free survival rates at 1, 3, and 5 years were 96.6%, 93.5%, and 64.2%. There was no statistically significant difference in overall survival time between patients within and beyond the Milan criteria. Factors affecting recurrence were the tumor grade, lobar distribution, size of the largest nodule, and the total tumor burden in the explanted liver. Recurrence adversely affected survival. CONCLUSIONS: Using our criteria of a single tumor ≤ 6 cm, or 2 to 3 tumors with the largest ≤ 4.5 cm, or 4 to 5 tumors with the largest ≤ 3 cm and total tumor size ≤ 8 cm resulted in overall survival comparable to patients within the Milan criteria.

Multidisciplinary treatment in children with non-metastatic hepatoblastoma: treatment results at the National Cancer Institute, Cairo University.

PURPOSE: The aim of this study is to evaluate our experience at the NCI, Cairo University in the management of non- metastetic hepatoblastoma (HB). Also to improve survival of children with HB and reduce the operative morbidity and mortality by using preoperative chemotherapy. PATIENTS AND METHODS: After biopsy and assessment of the extent of disease, all patients were treated with a 6-hour continuous intravenous infusion of cisplatin (PLA) 90mg/m2 on day one followed by doxorubicin (DO) 20mg/m2 per day administered as 1- hour infusion on days 2,3 and 4. After four courses of preoperative chemotherapy, patients were reassessed. Whenever possible, the primary tumor was resected and the treatment was completed with two more courses of chemotherapy. RESULTS: Twenty children with HB were registered between January 1999 and December 2000, the median age at diagnosis was 12 months (range, 40 days to 11 years). All the 20 patients had received preoperative chemotherapy (PLADO). Fifteen patients (75%) showed partial response with tumor shrinkage and serial decrease of serum alpha-fetoprotein levels. Sixteen patients underwent surgery, fourteen of them had complete resection of the primary tumor (87.5%). The median duration of followup was 26 months (range 1-55 months). The three year disease-free survival was 68.4% and event-free survival was 65%. CONCLUSION: We can advocate the use of PLADO chemotherapy and delayed surgery to be the standard treatment for children with HB. Other treatment programs should be measured against this standard.