Abstract:

Objective The risk factors of liver transplantation（LT）for hepatocellular carcinoma（HCC） associated with hepatitis B virus（HBV）and cirrhosis have not been well defined. This study examines the factors that may affect LT outcome for HCC patients with HBV-induced cirrhosis（HBV-cirrhosis）. Methods From 2005 to 2010，309 HCC patients with HBV-cirrhosis underwent LTs with antiviral prophylaxis were performed inthe study. Results Stratified univariate and multivariate analyses demonstrated that independent predictors for a lower recurrence-free survival rate were ① a tumor size ＞ 7.5 cm（P ＝ 0.011）；② total number of tumors ＞ 4（P ＝ 0.006）；③ pre-LT serum alpha-fetoprotein（AFP）level ≥ 2 000 μg/L（P ＝ 0.024），④ vascular invasion （P ＝ 0.048）；⑤ pre-LT aspartate aminotransferase（AST）level ≥ 3 N（3 x the normal level）（P ＝ 0.043），and ⑥ pre-LT alkaline phosphatase（ALP）level ≥ 2N（P ＝ 0.005）. Moreover，pre-LT therapy for HCC was an independent prognostic indicator of better survival（P ＝ 0.021），while pre-LT AFP level ＞ 5 000 μg/L was a high risk predictor of worse survival（P ＝ 0.000）. Conclusion Pre-LT classified tumor characteristics combined with pre-LT high serum levels of AST，ALP and AFP can be reliable predictors of LT outcome in HCC patients with HBV.