The aim of this study was to collect data from patients who underwent liver transplantation (LT) for adenomatosis; to analyze the symptoms, the characteristics of the disease, and the recipient outcomes; and to better define the role of LT in this rare indication. This retrospective multicenter study, based on data from the European Liver Transplant Registry, encompassed patients who underwent LT for adenomatosis between January 1, 1986, and July 15, 2013, in Europe. Patients with glycogen storage disease (GSD) type IA were not excluded. This study included 49 patients. Sixteen patients had GSD, and 7 had liver vascular abnormalities. The main indications for transplantation were either a suspicion of hepatocellular carcinoma (HCC; 15 patients) or a histologically proven HCC (16 patients), but only 17 had actual malignant transformation (MT) of adenomas. GSD status was similar for the 2 groups, except for age and the presence of HCC on explants (P = 0.030). Three patients with HCC on explant developed recurrence after transplantation. We obtained and studied the pathomolecular characteristics for 23 patients. In conclusion, LT should remain an extremely rare treatment for adenomatosis. Indications for transplantation primarily concern the MT of adenomas. The decision should rely on morphological data and histological evidence of MT. Additional indications should be discussed on a case-by-case basis. In this report, we propose a simplified approach to this decision-making process.

Centre Hépato Biliaire INSERM U785 Hôpital Paul Brousse Villejuif France

Centre Hospitalier Régional Universitaire de Lille Lille France

Chirurgie Digestive Hôpital Saint Eloi Centre Hospitalier Universitaire Montpellier Montpellier France

Chirurgie Générale et Digestive et de la Transplantation Hépatique et Intestinale Hôpital de la Croix Rousse Centre Hospitalier Universitaire Lyon Lyon France

Chirurgie Générale et digestive Hôpital de la Conception Centre Hospitalier Universitaire Marseille Marseille France

Chirurgie Générale et Digestive Hôpital de Rangueil Centre Hospitalier Universitaire Toulouse Toulouse France

Chirurgie Hépato Biliaire et Digestive Centre Hospitalier Universitaire Tours

Chirurgie Hépatobiliaire et Pancréatique Centre Hospitalier Universitaire Bordeaux Maison du Haut Lévèque Bordeaux France

Cliniques Universitaires Saint Luc Brussels Belgium

Department of General and Hepato Biliary Surgery Liver Transplantation Service Ghent University Hospital Ghent Belgium

Department of General Surgery and Transplantation Niguarda Ca'Granda Hospital Milan Italy

Department of General Visceral and Transplant Surgery Hannover Medical School Hanover Germany

Department of Surgery Ospedale Papa Giovanni XXIII Bergamo Italy

ELTR and ELITA Board www eltr org Centre Hépato Biliaire INSERM U785 Hôpital Paul Brousse Villejuif France

General and Digestive Surgery Department Hospital Universitario Central de Asturias Oviedo Spain

Hepato Biliary Surgery and Liver Transplantation Unit Hospital Universitario de Cruces Bilbao Spain

Hepato Pancreato Biliary Surgery and Liver Transplantation Unit Istituto Nazionale Tumori IRCCS Foundation Milan Italy

Hôpital de Haute Pierre Service de Chirurgie Hépatique et Transplantation Centre Hospitalier Universitaire Strasbourg Strasbourg France

Instituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione University of Pittsburgh Medical Center in Italy Palermo Italy

Service d'Hépato Gastro Entérologie Hôpital Edouard Herriot Centre Hospitalier Universitaire Lyon Lyon France

Service de Chirurgie Digestive et Centre de Transplantation Hépatique de l'Hôpital de l'Archet Centre Hospitalier Universitaire Nice Nice France

Service de Pathologie INSERM U1053 Université Bordeaux Segalen Hôpital Pellegrin Bordeaux France

Transplant Surgery Department Institute for Clinical and Experimental Medicine Prague Czech Republic ELTR and ELITA Board www eltr org

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$a Liver transplantation for adenomatosis: European experience / $c L. Chiche, A. David, R. Adam, MM. Oliverius, J. Klempnauer, E. Vibert, M. Colledan, J. Lerut, VV. Mazzafero, S. Di-Sandro, C. Laurent, V. Scuderi, B. Suc, R. Troisi, P. Bachelier, J. Dumortier, J. Gugenheim, JY. Mabrut, I. Gonzalez-Pinto, FR. Pruvot, YP. Le-Treut, F. Navarro, J. Ortiz-de-Urbina, E. Salamé, M. Spada, P. Bioulac-Sage,

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