Fatores de risco para recorrência do carcinoma hepatocelular após transplante hepático

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor, with annual worldwide incidence of over one million cases, accounting for at least 500,000 deaths per year. The majority of cases of HCC occur in the setting of liver cirrhosis. Liver transplantation (LT) is a curative treatment modality for HCC. However the recurrence of HCC after LT is the main obstacle to the success of this treatment. The aim of this study was to evaluate the risk factors for recurrence of hepatocellular carcinoma after conducting LT. In this retrospective, descriptive and analytical study, between May 2002 and April 2012, were conducted 664 liver transplantations (LT) at HUWC – UFC, among which 140 LT were performed in patients with HCC. The risk factors of HCC recurrence after liver transplantation were analysed. The variables analyzed were: sex, age, blood type, etiology of cirrhosis, alpha-fetoprotein level, diagnostic imaging, Milan criteria, time from diagnosis of HCC and the realization of LT, time on the waiting list for the LT and pathological tumor characteristics in explant. The tumor was more frequent in men with an average age of 56 years, infected with hepatitis C virus. The rate of HCC recurrence after LT was 8, 57 % and occurred more often in the first two years after transplantation, with the liver graft being the most common site. In conclusion, independent risk factors for carcinoma hepatocellular recurrence after liver transplantation were: time in the LT waiting list above 7,8 months, liver number nodules over 3.5 nodules, tumors exceeding the Milan criteria, level of alphafetoprotein above 1000 ng/ml and presence of micro-vascular invasion.