Prognostic factors in patients with recurrent hepatocellular carcinoma treated with salvage liver transplantation: a single-center study

Abstract

Although salvage liver transplantation (LT) has been widely adopted as a treatment for recurrent hepatocellular carcinoma(HCC), candidate selection criteria have not been established. This single-center study aimed to identify risk factors associated with HCC recurrence and survival following salvage LT. The study included 74 patients treated with salvage LT between October 2001 and February 2013. The median follow-up was 37.2 months after LT. There were 29 cases of HCC recurrence and 31 deaths following LT. Microvascular invasion at the time of liver resection, a time interval to post-LR HCC recurrence of ≤ 12months, an alpha-fetoprotein level at LT greater than 200 ng/mL, and having undergone LT outside of the UCSF criteria were independent risk factors for HCC recurrence after salvage LT. Patients with no more than one risk factor had a 5-year recurrence-free survival rate of 71.2% compared to 15.9% in patients with two or more risk factors. These findings suggest that to avoid post-LT HCC recurrence and a dismal prognosis, patients with no more than one risk factor for recurrence should be given priority for salvage LT. These criteria may improve the outcomes of patients treated with salvage LT and facilitate the effective use of limited organ supplies.

Hepatocellular carcinoma: when is liver transplantation oncologically futile?

“…Patients with no more than one risk factor had a 5-year recurrence-free survival rate of 71% compared to 16% in patients with two or more risk factors (27). The results of the second study, which only included patients within the Milan criteria undergoing liver resection or living-donor LT, were even more striking.…”

“…Recurrence within the first 8-12 months after liver resection is an independent risk factor for recurrence after subsequent salvage transplantation (26,27). In contrast, longer recurrence free intervals after pre-LT treatment select patients with a low post-LT recurrence risk.…”

“…Therefore AFP is a well-established surrogate of tumor biology as it correlates with histologic grading and vascular invasion (14,(41)(42)(43). Not surprisingly, a large number of studies have highlighted the importance of increased AFP values for the recurrence risk after LT (3,23,(25)(26)(27)39,(41)(42)(43)(44)(45)(46)(47)(48). It is important to note that increased AFP values are not only a risk factor in patients beyond but also in patients within the Milan criteria.…”

Curative salvage liver transplantation in patients with cirrhosis and hepatocellular carcinoma: An intention‐to‐treat analysis

“…The reported actual transplantability rate of HCC recurrence following primary resection (which occurs in up to 70% of cases at 5 years) is below 50% in most series (http://onlinelibrary.wiley.com/doi/10.1002/hep.29468/suppinfo). Thus, successful SLT strategy cannot be guaranteed to the patient before liver resection.…”

Enhanced circulating transforming growth factor beta 1 is causally associated with an increased risk of hepatocellular carcinoma: a mendelian randomization meta-analysis

“…The incidence rate of hepatocellular carcinoma stems mainly from several risk factors, including gender, race/ethnicity, chronic viral hepatitis and alcoholism [27, 28]. There is also compelling evidence for genetic predisposition to hepatocellular carcinoma and TGFB1 gene is one of promising candidates [29, 30].…”