A. Kornberg

18F‐FDG‐Uptake of Hepatocellular Carcinoma on PET Predicts Microvascular Tumor Invasion in Liver Transplant Patients

Vascular invasion of hepatocellular carcinoma (HCC) is a major risk factor for poor outcome after liver transplantation (LT). The aim of this retrospective analysis was to assess the value of preoperative positron emission tomography (PET) using 18F‐fluorodeoxyglucose (18F‐FDG) in liver transplant candidates with HCC for predicting microvascular tumor invasion (MVI) and posttransplant tumor recurrence.

Long-term survival after recurrent hepatocellular carcinoma in liver transplant patients: Clinical patterns and outcome variables

BACKGROUND The objective of this trial was to analyze the clinical patterns and outcome variables of recurrent hepatocellular carcinoma (HCC) in liver transplant patients. PATIENTS AND METHODS Sixty patients after liver transplantation (LT) for HCC were analyzed. All of them received initially a calcineurin-inhibitor based immunosuppressive regimen. Recurrent HCC was treated by surgical intervention, if eligible, or adjuvant therapies. Furthermore, patients were converted to a Sirolimus (SRL)-based immunosuppressive regimen after tumor relapse. The impact of clinical and histopathological variables on post-recurrence survival was analyzed in uni- and multivariate analysis. RESULTS Sixteen liver recipients developed HCC recurrence between 4 and 58 months (median: 23 months) post-LT. Sites of first tumor recurrence were lung (n = 5), liver (n = 4), bone (n = 4), cerebrum (n = 1), adrenal gland (n = 1) and peritoneum (n = 1). Seven patients were amenable for surgical resection, while 9 patients were only suitable for adjuvant treatment (n = 4) or general medical support (n = 5). Median survival rate post-recurrence was 65 months (range: 12-136 months) in patients amenable for surgical therapy, and 5 months (range: 1-52 months) in patients unsuitable for surgical intervention (P = 0.01). Multivariate analysis identified late (>24 months) posttransplant tumor relapse (P = 0.039) and surgical therapy (P = 0.014) as independent predictors of long-term survival after tumor relapse. Five patients are tumour-free alive for a median of 65 months after surgical resection of recurrent HCC and conversion to SRL. CONCLUSION Liver transplant patients with HCC recurrence should be treated surgically, if eligible, since this is an independent predictor of long-term survival.

Increased 18F-FDG uptake of hepatocellular carcinoma on positron emission tomography independently predicts tumor recurrence in liver transplant patients.

The aim of this retrospective trial was to analyze the value of preoperative (18)F-fluoro-deoxyglucose positron emission tomography ((18)F-FDG PET) to predict parameters of tumor aggressiveness among liver transplant (OLT) patients with hepatocellular carcinoma (HCC). Fifty-five patients with HCC underwent (18)F-FDG-PET during evaluation for OLT. Nineteen patients demonstrated increased (18)F-FDG uptake on PET pre-OLT (PET(+)), and 36 patients revealed negative PET findings (PET(-)). PET(+) patients showed a relative risk of 9.5 and 6.4 for poor differentiation and for microvascular invasion (MVI) in the HCC at explant pathology, respectively. Of the 10 patients (18.2%) who developed HCC recurrences, 9 (90%) revealed increased (18)F-FDG uptake pre-OLT; only 1 (10%) showed a PET(-) status (P < .001). Apart from poor tumor differentiation, PET(+) status was identified as an independent predictor of tumor recurrence post-OLT (odds ratio, 23.9). Our study demonstrated that (18)F-FDG uptake on PET is a reliable preoperative predictor of tumor recurrence after OLT in patients with HCC, triggered by its high association with poor tumor differentiation and MVI.

Recurrence‐Free Long‐Term Survival After Liver Transplantation in Patients with 18F‐FDG Non‐Avid Hilar Cholangiocarcinoma on PET

The aim of this retrospective study was to assess the value of 18F‐fluorodeoxyglucose positron emission tomography (18F‐FDG‐PET) for predicting biological tumor behavior and outcome after liver transplantation (LT) in patients with otherwise unresectable hilar cholangiocarcinoma (HC). Preoperative 18F‐FDG‐PET scanning was performed in 13 patients with type IV Klatskin tumor before LT. PET+ status indicated patients with an increased pretransplant 18F‐FDG uptake, whereas PET− recipients had no increased preoperative 18F‐FDG uptake on PET. Pretransplant PET findings were correlated with histopathological tumor characteristics and patient outcome after LT. Eight patients demonstrated positive preoperative PET findings (61.5%), whereas five patients had no increased preoperative 18F‐FDG tumor uptake (38.5%) on PET. One PET+ patient died after 1 month due to liver allograft dysfunction. Seven PET+ liver recipients developed tumor recurrence, whereas five PET− patients were tumor‐free alive after a median of 76 months post‐LT (p = 0.001). The 2‐year recurrence‐free survival rate after LT was 100% in PET− patients and 28.6% in the PET+ population (log‐rank = 0.008). Our results suggest that patients with 18F‐FDG non‐avid HC on PET may achieve recurrence‐free long‐term survival after LT.

Conversion to mycophenolate mofetil for modulating recurrent hepatitis C in liver transplant recipients

Abstract: Background. The aim of this study was to analyze the influence of cyclosporine A (CsA) taper in conjunction with mycophenolate mofetil (MMF) therapy on recurrent hepatitis C virus (HCV) in liver transplant patients.

Adjuvant conversion to sirolimus in liver transplant patients with recurrent hepatocellular carcinoma – preliminary results

The adoption of the Milan criteria a decade ago has significantly improved the outcome of liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) [1]. The application of new techniques for pretransplant tumor ‘downsizing’ and ‘downstaging’, as well as the introduction of living donor LT with hence reduced time on the waiting list, has recently stimulated a controversy about the expansion of tumor burden limits [2–5]. The acceptance of extended HCC criteria in the transplant setup will very much depend on the prognosis of recipients suffering from recurrent HCC, as tumor recurrence is the major factor of mortality in this special patient population [6]. However, the therapeutic possibilities for immunocompromized LT patients with HCC recurrence are still very limited [7,8]. Against this background, the introduction of an immunosuppressant with antineoplastic activity might be inherently attractive. Sirolimus (SLR) is a macrocyclic triene antibiotic that was found to have potent immunosuppressive and antiproliferative capabilities, which may offer a new approach in the treatment of recurrent HCC post-LT [9]. We describe here our first experiences with an adjuvant conversion to an SRL-based immunosuppression in a cohort of liver recipients with HCC recurrence.

Stellenwert der Lebertransplantation beim malignen Lebertumor — Erfahrungen bei 40 Patienten

Hintergrund: In Anbetracht des gravierenden Organmangels mus die Indikation zur Lebertransplantation (LTX) beim malignen Lebertumor kritisch uberdacht werden. Patienten und Methoden: Im Zeitraum zwischen 1/1992 und 12/1999 haben wir insgesamt 209 LTX durchgefuhrt. In 53 Fallen handelte es sich um einen malignen Lebertumor (25,3%). Es zeigte sich kein signifikanter Unterschied im 5-Jahresuberleben zwischen Patienten mit benigner Grunderkrankung (75,6%) und Patienten mit einem Lebermalignom (63,4%). In 37 Fallen lag ein primares Lebermalignom vor (34× HCC; 3 × CCC). Patienten mit einem HCC hatten eine 5-Jahresuberlebenswahrscheinlichkeit von 70,6%, ohne eindeutige Korrelation zum UICC-Studium des Tumors. Alle drei Patienten mit einem CCC sind am Leben, davon 2 Patienten mittlerweile uber 90 Monate nach LTX. Zusammenfassung: Patienten mit einem primaren Lebermalignom konnen nicht prinzipiell von einer LTX ausgeschlossen werden. Den Sinn der UICC-Klassifikation fur die Indikationsstellung zur LTX gilt es zu uberdenken.