Survival after Liver Transplantation for Hepatocellular Carcinoma in Hispanics From the South of Puerto Rico

Purpose: Liver transplant (LT) is a potentially curative treatment for patients with hepatocellular carcinoma (HCC). Excellent results can be achieved in patients with solitary, <5-cm tumor or with up to three nodules smaller than 3 cm (MILAN criteria). It has been reported that the 5-year survival is very similar to patients without HCC who undergo LT (approximately 75%). The aim of our study is to review the survival rate, etiology, recurrence, and incidental HCC in Hispanic patients from the South of Puerto Rico, who underwent LT for HCC. Methods: We reviewed all patient records from our clinic who underwent LT from September, 2005 to December, 2012. A data collection was obtained to identify those with HCC to determine age, sex, MELD score, chronic liver disease etiology, and survival. Of the 80 patients who underwent LT, 32 (40%) fulfilled the inclusion criteria. Results: Of the 32 patients with HCC, 25/32 (78%) had established HCC (eHCC) before the LT, and 7/32 (22%) had incidental HCC (iHCC). The mean age was 59.18 years old. 78% (25/32) of our patients were males, and 22% (7/32) were females. The liver disease etiologies for eHCC was 56% (14/25) HCV, 28% (7/25) NASH, 12% (3/25) alcoholic, and 4% (1/25) Alpha 1 antitrypsin deficiency. The etiology for iHCC included 28.6% (2/7) Alcohol, 14.2% (1/7) Alpha 1 antitrypsin deficiency, 14.2% (1/7) HCV and alcohol, 14.2% (1/7) HCV and HBV, 14.2% (1/7) NASH, and 14.2% (1/7) Cryptogenic. LT survival was 100% (32/32) at 1 month, 100% (31/31) at 1 year, and 90.48% (19/21) at 3 years. Our recurrence rate at 3 years was 1/21 (4.8%). The causes of death were recurrent HCC with metastatic disease and recurrent HCV with liver failure. Conclusion: Our results demonstrate the known good prognosis of LT for HCC when meeting the MILAN criteria. Survival was superior to most studies in the U.S. and Puerto Rico. We also had a very low HCC recurrence. All of our patients undergo a very close surveillance, including CT scan and alpha-fetoprotein, according to the pathology found in the recipient's liver. Another interesting finding in our study was the high incidence of HCC 32/80 (40%) among our LT patients. This is higher than the National incidence reported, which is 34%. We also found that only 8.75% (7/80) had iHCC. This is lower than most national studies showing 20% iHCC. We have observed a high incidence of diabetes, obesity, and metabolic syndrome among our transplant patients. Previous studies have proposed obesity and diabetes as possible risk factors for HCC. In conclusion, we are reporting an excellent survival in patients who had LT indicated for HCC. We also noted a high incidence of HCC and a low incidence of iHCC among our LT patients. Our patients had a low rate of HCC recurrence after LT.