Prospective validation of "ab initio" liver transplantation in XXXX upon detection of risk factors for recurrence after resection.

@entity1 @entity157 @entity5
INTRODUCTION: A decade ago we proposed to enlist for transplantation those @entity1 with resected @entity157 ( @entity157 ) in whom pathology registered pejorative histological markers (microvascular invasion and/or satellites) (ab initio indication) and not wait for the appearance of recurrence. This study evaluates the outcome of this approach. METHODS: From 1995 to 2012, 164 @entity1 with @entity157 underwent resection. Eighty-five @entity1 were potential candidates to liver transplantation (LT) and were considered for it upon detection of pejorative histological markers. @entity1 without these markers were followed and salvage LT was considered upon development of @entity5 recurrence/liver function impairment. RESULTS: Thirty-seven @entity1 were at high-risk and 48 at low-risk of recurrence at pathology. Twenty-three out of 37 high-risk @entity1 recurred during follow-up, but in 9 of them the @entity5 burden extent contraindicated LT. Seventeen were finally transplanted: 10 of them presented recurrence at imaging/explant. After a median post-transplant follow-up of 50.9 months, @entity157 had recurred in 2 @entity1 and 5 @entity1 had died, the 5-year survival being 82.4%. Twenty-six of the 48 low-risk @entity1 developed recurrence and 11 of them were transplanted. After a median post-transplant follow-up of 59 months, two @entity1 developed recurrence and 5 died, their 5-year survival being 81.8%. CONCLUSIONS: Enlistment of @entity1 at high-risk of recurrence after resection before recurrence development seems a valid strategy and is associated with excellent long-term outcome. Since early (<6 months) recurrence reflects an aggressive @entity5 behavior leading to @entity5 extent exceeding transplant criteria, we propose to wait at least 6 months before enlistment. However, once included in the waiting list, priority strategies should be implemented in order to reach effective transplantation prior to the appearance of recurrence. This article is protected by copyright. All rights reserved.
