Purpose

Studies suggest that vascular invasion may be a superior prognostic marker compared with traditional selection criteria, e.g. Milan criteria. We aimed to investigate the prognostic value of vascular invasion in a large database material.

Methods

We included patients liver transplanted for HCC and cirrhosis registered in the European Liver Transplant Registry (ELTR) database. The association between the Milan criteria, Up-to-seven criteria and vascular invasion with overall survival and HCC specific survival was investigated with univariate and multivariate Cox regression analyses.

Results

Of 23,124 patients transplanted for HCC, 9,324 had cirrhosis and data on explant pathology. Patients without microvascular invasion, regardless of number and size of HCC nodules, had a five-year overall survival of 73.2%, which was comparable with patients inside both Milan and Up-to-seven criteria. Patients without macrovascular invasion had an only marginally reduced survival of 70.7% after five years. Patients outside both Milan and Up-to-seven criteria without vascular invasion still had a five-year overall survival of 65.8%.

Discussion

Vascular invasion as a prognostic indicator remains superior to criteria based on size and number of nodules. With continuously improving imaging studies, vascular invasion may be used for selecting patients for transplantation in the future.

CITATION INFORMATION: Pommergaard H-.C., Rostved A., Adam R., Thygesen L., Salizzoni M., Bravo M., Cherqui D., Filipponi F., Boudjema K., Mazzaferro V., Soubrane O., García-Valdecasas J., Prous J., Pinna A., O'Grady J., Karam V., Duvoux C., Rasmussen A. Vascular Invasion and Survival after Liver Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry Am J Transplant. 2017;17 (suppl 3).

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