Pretransplantation Imaging and Histopathology of the explanted liver.
Of the 175 patients who were included,
122 (69,7%) patients had evidence of viable tumor on imaging examination,
whereas 125 patients (71,4%) had evidence of viable tumor on histopathology.
Among the 53 patients who had no evidence of viable tumor at the imaging examination performed closest to LT,
a previous dynamic MDCT or MRI performed within 6 months to LT was available in 41 patients,
allowing the evaluation of the enhancement pattern.
On a total of 163 cases in which evaluation of enhancement pattern was possible,
156 (95,7%) showed wash-in during the arterial phase,
and then were classified as hypervascular,
while 7 (4,3%) were classified as hypovascular for the absence of wash-in.
With respect to the pathological differentiation degree,
of the 125 patients with histopathological evidence of viable tumor,
19 (15,2%) had well-differentiated HCC (grade 1),
56 (44,8%) grade 2,
40 (32%) grade 3 and 4 (3,2%) grade 4.
In 6 patients (4,8%) differentiation degree was not assessable.
In 113 patients enhancement pattern as well as differentiation degree information were available.
A significant association was found between imaging enhancement pattern and histopathological differentiation degree (p<0.05) (Table 2) (Fig.
The median follow-up period was 39,1 months.
Of the 175 patients included,
24 (13,7%) had recurrence of HCC after the LT.
Time to development of the recurrence ranged from 1,55 to 41,85 months after LT,
with a median value of 12,36 months.
5-years cumulative disease-free survival rates according to the Kaplan-Meier method were 92,96%,
83,9% and 82,84%,
The mean duration of recurrence-free survival was 40,15 months.
Three patients (12,5%) experienced late recurrence (≥2 years after LT),
with a rate of 1,7% (3/175).
With respect to location,
at the moment of the first recurrence,
14 patients (58,3%) showed extrahepatic recurrence ,
7 patients (29,2%) had intrahepatic recurrence and 3 patients (12,5%) showed both intrahepatic and extrahepatic recurrence.
Eight patients had more than one recurrence site at the moment of the first recurrence.
Only one of the 3 patients with late recurrence had intrahepatic recurrence.
Recurrence patterns and characteristics of recurrence are further described in table 3 and illustrated in figure 2.
Among the 14 patients who didn’t show early hepatic recurrence,
4 had evidence of late hepatic recurrence in further follow-up imaging examinations.
On a total of 14 patients with early or late intrahepatic recurrent HCC,
12 had hypervascular and 2 hypovascular enhancement pattern.
Nine of them underwent liver biopsy with histological diagnosis of HCC,
4 scored as grade 2 and 5 scored as grade3.
Two patients (14,3%) showed a variation in imaging characteristics between the primary HCC (hypervascular) and the intrahepatic recurrent HCC (hypovascular) (Fig.
they didn’t show any variation in histopathological characteristics.
Only 1 patient,
who had hypervascular enhancement pattern on pretransplantation imaging as well as on recurrence imaging,
had a variation of histopathological characteristics (from moderate to poor differentiation) (Fig.
no association was found between imaging and histopathological variations.