Liver transplantation feasible for benign solid tumors of the liver

Last Updated: 2015-03-04

By Will Boggs MD

NEW YORK (Reuters Health) - Liver transplantation is a viable option for patients with benign solid tumors of the liver that are not amenable to resection, researchers report.

Only about 6% of patients with benign solid liver tumors (BSLT) require surgery for symptoms, uncertain diagnosis, or prevention of complications or malignant transformation, they write in JAMA Surgery, online February 25. The indications for liver transplantation for these benign neoplasms have yet to be defined.

Dr. Roberto Gedaly from the College of Medicine at the University of Kentucky in Lexington and colleagues evaluated the experiences of 147 U.S. patients from the United Network of Organ Sharing (UNOS) data set who underwent liver transplantation for BSLT.

These patients represented only 0.17% of the more than 87,000 liver transplantations between October 1988 and January 2013, according to their report.

Diagnoses included adenoma in 42.2% of patients, focal nodular hyperplasia (FNH) in 19.7%, hemangioma in 17%, hepatic epithelioid hemangioendothelioma in 7.5%, and benign liver tumors that were unknown at the time of transplantation in 13.6%.

Most patients received livers from deceased donors (92.5%), and 47.6% of patients had upper abdominal surgery at the same time as or before the transplantation procedure.

California and Texas (with 16 transplants each) led the list, followed by Florida (with 13) and Pennsylvania (with 11), the researchers say.

Transplant centers can apply for a Model for End-Stage Liver Disease (MELD) exception for patients whose medical urgency is not reflected by their MELD scores. That occurred for 69.9% of patients transplanted after implementation of MELD in 2002.

Twenty patients (13.6%) were treated for acute cellular rejection within six months, but 89.8% of patients had a functioning graft during the mean follow-up time of 79.2 months.

Overall survival rates were 90.9% at one year, 85.2% at three years, and 81.8% at five years, and overall graft survival rates were 85.6%, 79.7% and 75.6%, respectively.

Age was the only independent factor associated with survival in patients who underwent transplantation for BSLT.

"Although liver transplantation cannot be considered a first-line treatment for patients with a diagnosis of BSLT, it is a valid therapeutic option in selected patients who are not amenable to resection," the researchers conclude. "Future studies are needed to determine the real role of liver transplantation in the treatment of BSLT."

Dr. Laurence Chiche, who has published several reports on managing benign liver tumors, told Reuters Health by email, "Liver transplantation should indeed be discussed if the tumors 1) present one or more of these three conditions: malignant transformation, uncontrolled iterative hemorrhages, severe symptoms impairing life; and 2) cannot be treated by partial liver resection."

"This paper is interesting, but it reports a large experience during a very long period," explained Dr. Chiche, from Groupe Hospitalier Sud - Maison du Haut Lévêque in Pessac, France. "Today, lots of things have changed concerning the expertise of partial liver resection and the knowledge in the field of BSLT (adenomas and FNH). So it is time to define the real good indications and this probably should remain a case by case discussion considering: the patients (age, symptoms), the tumors (histology), the reasons of unresectability, and the non-tumoral liver (vascular abnormalities, genetic disease, etc.)."

"A prospective registry of those patients would be very helpful," he concluded.

Dr. Gedaly did not respond to a request for comments.

SOURCE: http://bit.ly/1zITa0l

JAMA Surg 2015.