Adult liver transplant for hepatocellular carcinoma at Wits Donald Gordon Medical Centre in Johannesburg, South Africa

Keywords: liver transplantation, hepatocellular carcinoma, survival, South Africa, locoregional therapy

Abstract

Background: For those with unresectable hepatocellular carcinoma, liver transplantation is considered the treatment of choice. Since 2006, the transplant programme at Wits Donald Gordon Medical Centre (WDGMC) has offered liver transplantation for selected patients with hepatocellular carcinoma. While the number of patients transplanted was small, we are unaware of any published data from Southern Africa describing outcomes in this group of liver transplant recipients. The aim of this study was to describe our experience as a case series.

Methods: The records of all patients with HCC who underwent deceased donor liver transplantation between April 2006 and March 2018 were reviewed retrospectively. Data were extracted from transplant clinic patient files, histopathology and pathology laboratory reports and an existing database of all liver transplant recipients at WDGMC. Patient survival was calculated from the time of transplant and survival estimates were determined by the Kaplan-Meier method.

Results: Thirty-one liver transplants were reviewed. The most common causes of underlying liver disease were infectious, mostly hepatitis B virus, and diseases of lifestyle including alcoholic/non-alcoholic steatohepatitis. Median age at transplant, 57 years (IQR 44–65 years), was younger than observed internationally, but consistent with reports from Africa. Male recipients predominated, in keeping with published trends. Overall, outcomes were worse than expected but for recipients who were within the University of California at San Francisco (UCSF) criteria for transplantation; survival was comparable to previously published data.

Conclusions: Despite limitations, this is the first documented series of patients undergoing liver transplantation for HCC in South Africa and demonstrates that good results can be achieved in appropriately selected patients.

Author Biographies

M Dempster, University of the Witwatersrand

Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, Charlotte Maxeke Johannesburg, Academic Hospital, Johannesburg, South Africa

C Bouter, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Johannesburg, South Africa

H Maher, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Johannesburg, South Africa

P Gaylard, University of the Witwatersrand

Data Management and Statistical Analysis, University of the Witwatersrand, Johannesburg, South Africa

H Etheredge, University of the Witwatersrand

Wits Donald Gordon Medical Centre, Johannesburg and Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

J Fabian, University of the Witwatersrand

Wits Donald Gordon Medical Centre, Johannesburg and Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

A Mahomed, University of the Witwatersrand

Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg and Transplant Unit, Wits Donald Gordon Medical Centre, Johannesburg, South Africa

J Botha, University of the Witwatersrand

Transplant Unit, Wits Donald Gordon Medical Centre, Johannesburg and Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Published
2019-07-11
How to Cite
Dempster, M., Bouter, C., Maher, H., Gaylard, P., Etheredge, H., Fabian, J., Mahomed, A., & Botha, J. (2019). Adult liver transplant for hepatocellular carcinoma at Wits Donald Gordon Medical Centre in Johannesburg, South Africa. South African Journal of Surgery, 57(3), 6-10. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3067
Section
Transplantation