Multicenter Italian Experience in Liver Transplantation for Hepatocellular Carcinoma in HIV‐Infected Patients

• Published in: The oncologist (Dayton, Ohio) Vol. 18; no. 5; pp. 592 - 599
• Main Authors: Di Benedetto, Fabrizio, Tarantino, Giuseppe, Ercolani, Giorgio, Baccarani, Umberto, Montalti, Roberto, De Ruvo, Nicola, Berretta, Massimiliano, Adani, Gian Luigi, Zanello, Matteo, Tavio, Marcello, Cautero, Nicola, Tirelli, Umberto, Pinna, Antonio D., Gerunda, Giorgio E., Guaraldi, Giovanni
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01-05-2013
• Subjects: Adult; Aged; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Carcinoma, Hepatocellular - virology; Female; Follow-Up Studies; HCV; Hepatobiliary; Hepatocellular carcinoma; HIV; HIV Infections - complications; HIV Infections - pathology; HIV Infections - therapy; HIV Infections - virology; HIV-1 - pathogenicity; Humans; Italy; Liver Neoplasms - complications; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver Neoplasms - virology; Liver Transplantation; Male; Middle Aged; Neoplasm Recurrence, Local - pathology; Survival Rate; Treatment Outcome; Italy; Hepatocellular carcinoma; HCV; HIV; Liver transplantation
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2012-0255

Learning Objectives
Compare clinical outcomes following liver transplant for heptaocellular carcinoma in patients with and without HIV infection.
Identify predictors of mortality following liver transplant for heptaocellular carcinoma in patients with and without HIV infection.
Background.
The aim of our work is to assess the clinical outcomes of liver transplantation (LT) for hepatocellular carcinoma (HCC) in HIV‐coinfected patients. This is a multicenter study involving three Italian transplant centers in northern Italy: University of Modena, University of Bologna, and University of Udine.
Patients and Methods.
We compared 30 HIV‐positive patients affected by HCC who underwent LT with 125 HIV‐uninfected patients who received the same treatment from September 2004 to June 2009. At listing, there were no differences between HIV‐infected and ‐uninfected patients regarding HCC features. Patients outside the University of California, San Francisco criteria (UCSF) were considered eligible for LT if a down‐staging program permitted a reduction of tumor burden.
Results.
HIV‐infected patients were younger, they were more frequently anti‐HCV positive, and a higher number of HIV‐infected patients presented a coinfection HBV‐HCV. Pre‐LT treatments (liver resection and or locoregional treatments) were similar between the two groups. Histological characteristics of the tumor were similar in patients with and without HIV infection. No differences were observed in terms of overall survival and HCC recurrence rates.
Conclusion.
LT for HCC is a feasible procedure and the presence of HIV does not particularly affect the post‐LT outcome.
摘要
背景. 本研究旨在评估肝细胞癌合并HIV感染患者肝移植（LT）术后的临床转归。这是一项多中心研究，共有3家意大利北部的移植中心参与，包括摩德纳大学、博洛尼亚和乌迪内大学。
患者和方法. 2004 ∼ 2009年间，我们比较了接受LT治疗的30例HIV阳性合并HCC患者和125例HIV阴性患者。在等待期，两组患者的HCC特征无差异。对于超出旧金山加利福尼亚大学标准（UCSF）的患者，如果降期方案可降低疾病负荷，亦可纳入研究接受LT术。
结果. HIV感染患者更年轻，HCV阳性率更高，此外HIV感染患者合并HBV‐HCV感染的比例更高。两组患者在LT术前接受的治疗（肝切除和/或局部治疗）相似。两组患者肿瘤组织学特征亦相似。未观察到总体生存和HCC复发率方面的差异。
结论. 对于HCC而言，LT是可行的手术。存在HIV感染并不会特别影响LT后的转归。TheOncologist 2013;18:592–599
Clinical outcomes of liver transplantation (LT) for hepatocellular carcinoma (HCC) in HIV‐coinfected patients were assessed. The study involved 30 HIV‐positive patients affected by HCC who underwent LT with 155 HIV‐uninfected patients who received the same treatment. LT for HCC is a feasible procedure and the presence of HIV does not particularly affect the post‐LT outcome.