Liver Transplantation for Recurrent Hepatocellular Carcinoma on Cirrhosis After Liver Resection: University of Bologna Experience

Abstract

According to intention-to-treat analysis of transplantable HCC patients who underwent LR (n = 80), compared to all those listed for transplantation (n = 293), 5-year overall survival was 66% in the LR group versus 58% in patients listed for LT, respectively (p = NS); 5-year disease-free survival was 41% in the LR group versus 54% in patients listed for LT (p = NS).Comparable 5-year overall (62% vs. 73%, p = NS) and disease-free (48% vs. 71%, p = NS) survival rates were obtained for SLT and primary LT for HCC, respectively. LR is a valid treatment for small HCC and in the event of recurrence, SLT is a safe and effective procedure.

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

“…[7][8][9][10][11][12][13] SLT has the lowest potential for re-recurrence, with a 5-year DFS rate of 48-67%. 8,11,24 A recent report showed a 5-year DFS rate of 60% after living-donor SLT for recurrent HCC within the Milan criteria. 15 However, a donor-pool shortage, lifelong immunosuppression and the technical demands of the procedure limit its use for all patients.…”

Treatment Algorithms for Managing Hepatocellular Carcinoma

“…27 An Italian study of liver transplantation (LT) as a salvage procedure (SLT) in the event of HCC recurrence found comparable overall (62% vs. 73%, P = NS) and disease-free (48% vs. 71%, P = NS) 5-year survival rates for SLT and primary LT (PLT) for HCC. 29 However, literature reports about SLT are conflicting. While Belghiti and Durand 28 found that both 3-year and 5-year overall survival rates in PLT and SLT recipients were similar (82% vs. 82% and 59% vs. 61%), as did Del Gaudio et al 29 and Vennarecci et al, 25 others reported an increased risk of recurrence (54% vs.18%), with a poorer 5-year overall (41% vs. 61%) as well as disease-free survival (29% vs. 58%) for SLT than for PLT.…”

“…29 However, literature reports about SLT are conflicting. While Belghiti and Durand 28 found that both 3-year and 5-year overall survival rates in PLT and SLT recipients were similar (82% vs. 82% and 59% vs. 61%), as did Del Gaudio et al 29 and Vennarecci et al, 25 others reported an increased risk of recurrence (54% vs.18%), with a poorer 5-year overall (41% vs. 61%) as well as disease-free survival (29% vs. 58%) for SLT than for PLT. 27 Since multiple challenges including shortage of organs, waiting list time, tumor biology, stage of tumor etc.…”

“…12 Recurrent HCC has been categorized based on morphology of recurrences 12 or timing of recurrence. 29 Based on morphology, recurrent HCC may be a) marginal (type 1) when recurrence is located near the resection margin b) nodular (type 2) when the single or double recurrent lesion is located more than 3 cm from the surgical scar and c) multi-nodular or diffuse (type 3) when the recurrence consists of many nodules scattered throughout the remaining liver or as an infiltrative lesion.…”

Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation

“…Liver resection can allow salvage LT to be performed as the only curative measure if the tumors are still within the criteria after a period of wait and see. Reports suggested that the post-operative course, complications, and the 3-and 5-year survival rates did not differ significantly between cirrhotic HCC patients undergoing primary LT or secondary LT after the initial liver resection (30), especially those tumors initially submitted to liver resection with the Milan criteria (31,32), or the UCSF criteria (33). In our centre, approximately 80% of patients were still eligible for salvage LT at the time of tumor recurrence (34).…”