Browsing by Author "Khalaf, Hatem"

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Liver Transplant for Hepatocellular Carcinoma: Experience in a Saudi Population
(Başkent Üniversitesi, 2008-03) Allam, Naglaa; Khalaf, Hatem; Fagih, Mosa; Al-Sebayel, Mohamed
Objectives: We present our experience with deceased-donor liver transplant and living-donor liver transplant for hepatocellular carcinoma. Between 2001 and 2007, we transplanted 133 organs (84 deceased-donor liver transplants, 49 living-donor liver transplants) in 126 patients (4 retransplants). Twenty-three patients had hepatocellular carcinoma (14 deceased-donor liver transplants and 9 living-donor liver transplants). Materials and Methods: The medical records of these patients were reviewed for recipient clinical, biochemical, and imaging characteristics. Slides of explants were assessed. Overall survival and tumor recurrence states were determined. All characteristics were tested for their prognostic significance. Results: The median age of the patients was 55 years and the median Mayo End-stage Liver Disease score was 16. The alpha-fetoprotein was ≥400 ng/mL in 4 patients. Histopathology revealed incidental cholangiocarcinoma in 2 patients and a hepatoblastoma in 1. The mean tumor size was 4 cm; the mean number of lesions was 2. Most tumors were graded as well or moderately differentiated; 4 were poorly differentiated. Gross macrovascular invasion was seen in 2 patients, while microvascular invasion was seen in 9. After a mean follow-up of 736 days, overall patient and graft survival rates were 80.9% and 76.2%; overall disease-free patient and graft survival rates were 76.2% and 71.4%. Two patients died of primary graft nonfunction within 1 week of the transplant. Three had tumor recurrence at 10, 13, and 18 months after transplant; 2 of these occurred in patients with cholangiocarcinoma. Two of these 3 died from an advanced tumor within few months. Significant risk factors for recurrence were gross major vessel invasion, microvascular invasion, tumor size, poor histologic differentiation, and absence of pretransplant tumor control therapy. The latter 2, in addition to Mayo End-stage Liver Disease score and preoperative alpha-fetoprotein, were independent predictors of mortality. Conclusions: In our small experience, deceased-donor liver transplant and living-donor liver transplant for hepatocellular carcinoma showed good long-term outcomes. Liver transplant for hepatocellular carcinoma accompanying cholangiocarcinoma had a poor outcome with late tumor recurrence. Use of marginal donors in patients with hepatocellular carcinoma might compromise the outcome in these patients.
Liver Transplantation in Patients With Hepatocellular Carcinoma: A Single-center Experience
(Başkent Üniversitesi, 2011-10) Azzam, Ayman Zaki; Sebayel, Mohammed Al; Sofayan, Mohammad Al; Al-hamoudi, Waleed; Abalkhail, Faisal; Kamel, Yasser; Mohammed, Hazem; Bahili, Hamad Al; Khalaf, Hatem; Hegab, Bassem
Objectives: Liver transplantation has become one of the best treatment options for early hepatocellular carcinoma in cirrhosis. We sought to study the results of liver transplantation in patients with hepatocellular carcinoma and to evaluate the outcome of the patients. Materials and Methods: The medical records of 256 recipients who underwent a liver transplantation from April 2001 to January 2010 were reviewed. One hundred seventy-six patients received their livers from deceased donors, and 80 received their livers from living donors. Fifty-two patients underwent liver transplantation for hepatocellular carcinoma. Results: From April 2001 until now, 52 patients (20.3%) underwent liver transplantation for hepatocellular carcinoma. Eighteen patients (34.6%) were performed from living-related donors, and 34 (65.4%) were from deceased donors. The patients were 37 males and 15 females (median, 55 years old; age range, 5 through 68 years). Model for end-stage liver disease score ranged from 6 to 40 with a median of 14. All patients were within the Milan criteria by the preoperative evaluation. Hospital stay ranged from 6 to 338 days with a median 14 days. Operating time ranged from 4 to 15 hours with a median 7.5 hours. Blood transfusion ranged from 0 to 19 units median 5 units. Thirty-four complications occurred in 23 patients (44.2%). Recurrence of hepatocellular carcinoma in 7 patients (13.5%), of which recurrent cholangiocarcinoma was diagnosed in 3 (5.7%), accidentally discovered in the explant. One deceased donor had hepatitis B core antibody positive. One explant showed macrovascular invasion. Sixteen patients died, 7 of 52 (13.5%) from hepatocellular carcinoma recurrence, including the 3 cases of accidental discovery of cholangiocarcinoma (5.7%). Conclusions: Apart from the common complications that can occur with any transplantation, liver transplantation remains the most-promising solution for patients with hepatocellular carcinoma among the available ones, and represents a cornerstone in managing hepatocellular carcinoma. It is the only acceptable option for complete eradication of both the disease and the predisposing factor.
Risk Factors for Biliary Complications After Living-Donor Liver Transplant: A Single-Center Experience
(Başkent Üniversitesi, 2008-06) Alawi, Khalil; Sebayel, Mohammed; Abdo, Ayman; Al-Hamoudi, Waleed; Al-Bahili, Hamad; Al-Sofayan, Mohamed; Al-Saghier, Mohamed; Allam, Naglaa; Medhat, Yaser; Khalaf, Hatem
Objectives: Biliary complications remain a major concern in living-donor liver transplant. They can lead to patient and graft loss. In this study, we retrospectively analyzed patients’ records to identify factors that increase the frequency of biliary complications in living-donor liver transplant with an aim toward decreasing this frequency. Materials and Methods: We performed 53 living-donor liver transplants between November 2002 and September 2007. Five cases were excluded because of graft or patient loss within 2 weeks resulting in 48 cases available for analysis. The effect of the following variables on the frequency of biliary complications was analyzed: recipient age, liver lobe used, number of graft bile ducts, number of biliary anastomoses, type of biliary anastomosis, and bile duct diameter 4 mm or smaller. Results: Biliary complications were seen in 14 cases (29.1%). These included 9 biliary strictures, 3 bile leaks, and 2 bile leaks eventually healing as biliary strictures. The presence of more than 1 graft bile duct increased the frequency of biliary complications (P = .03). The other variables did not have a statistically significant effect on the frequency of biliary complications. Conclusions: The rate of complications in our experience is comparable to that already published. The presence of more than 1 bile duct in the graft is a risk factor for biliary complications in living-donor liver transplant. A review of the data suggests additional risk factors.