The effect of hepatocellular carcinoma bile duct tumor thrombi in liver transplantation

Background/Aims: The presence of bile duct tumor thrombi (BDTT) of hepatocellular carcinoma (HCC) in explant liver is considered to be a poor prognostic factor. However, studies about HCC BDTT in liver transplant recipients are rare. We compared the characteristics of liver transplant recipients with HCC BDTT in their pathology with those of recipients who had portal vein tumor thrombi (PVTT) of HCC in their pathology. Methodology: The medical records of patients who underwent liver transplantation from 2002 to 2008 at Samsung Medical Center were reviewed. HCC recurrence was considered as an end-point. Results: Eight patients were identified as having HCC BDTT in explant liver. The disease-free survival rates at 1-year and 5-year were 37.5% and 25.0%, respectively. Patients whose HCC did not recur had lower alpha-fetoprotein (AFP) levels than others (P=0.046). Patients with HCC BDTT were compared with recipients who had PVTT in their pathology, and there was no statistically significant difference between the two groups (P=0.750). Conclusions: HCC BDTT of explant liver has been considered to be a poor prognostic factor, like PVTT of HCC. However, we found that patients with low AFP levels before transplantation could be expected to have a longer disease-free survival.