Abstract

        There is increasing evidence that a relevant number of patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria may benefit from liver transplantation (LT). We retrospectively analyzed the prognostic significance of (18) F-fluorodeoxy-glucose (FDG) positron emission tomography (PET) to identify appropriate liver transplant candidates with advanced HCC on clinical staging. Between 1995 and 2008, a total of 111 patients with HCC were listed for LT. All oft them underwent pretransplant PET evaluation. LT has been finally performed in 91 of them. Tumor recurrence rate post-LT was 3.6% in patients with (18) F-FDG non-avid (PET - status) but 54.3% in patients with (18) F-FDG avid (PET + status) tumors (P < 0.001), respectively. The overall 5-year recurrence free survival rate was comparable between patients with tumors meeting (86.2%) and patients with PET negative HCC exceeding the Milan criteria (81%) at LT, but significantly higher than in liver recipients with (18) F-FDG avid advanced HCC (21%; P = 0.002). On multivariate analysis, negative PET findings (odds ratio: 21.6; P < 0.001), AFP level below 400 IU/ml (odds ratio: 3.3; P = 0.013) and total tumor diameter below 10 cm (odds ratio: 3.0; P = 0.022) were identified as pretransplant available prognostic variables for recurrence-free survival. PET + status was assessed as the only independent clinical predictor of tumor-related patient drop out from the waiting list (hazard ratio 5.7; P = 0.01). Patients with (18) F-FDG non-avid HCC beyond the Milan criteria on clinical staging may achieve excellent recurrence-free long-term survival after LT. © 2011 American Association for the Study of Liver Diseases.

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