The management of post-transplantation recurrence of hepatocellular carcinoma

Abstract

The annual incidence of hepatocellular carcinoma (HCC) continues to rise. Over the last two decades, liver transplantation (LT) has become the preferable treatment of HCC, when feasible and strict selection criteria are met.With the rise in HCC-related liver transplantation, compounded by downstaging techniques and expansion of transplant selection criteria, a parallel increase in number of post-transplantation HCC recurrence is expected.Additionally, in the context of an immunosuppressed transplant host, recurrences may behave aggressively and more challenging to manage, resulting in poor prognosis. Despite this, no consensus or best practice guidelines for posttransplantation cancer surveillance and recurrence management for HCC currently exist. Studies with adequate population sizes and high-level evidence are lacking, and the role of systemic and locoregional therapies for graft and extrahepatic recurrences remains under debate. This review seeks to summarize the existing literature on posttransplant HCC surveillance and recurrence management. It highlights the value of early tumour detection, reevaluating the immunosuppression regimen, and staging to differentiate disseminated recurrence from intrahepatic or extrahepatic oligo-recurrence. This ultimately guides decision-making and maximizes treatment effect. Treatment recommendations specific to recurrence type are provided based on currently available locoregional and systemic therapies.

Prediction models of hepatocellular carcinoma recurrence after liver transplantation: A comprehensive review

“…For example, a recent study analyzing CT and MRI as deep learning methods presented a model that can detect a relatively high prediction rate (area under curve, 0.78-0.85) of microvascular invasion. 73 Independent of the criteria selection, a combination of immunosuppressants and mTOR inhibitors may be considered to reduce HCC recurrence after LT. 74 mTOR inhibitors such as sirolimus are known to have anticancer effects, whereas calcineurin inhibitors can promote cancer growth. 75,76 The re-cently published SiLVER (Sirolimus in Liver Transplant Recipients with HCC study) trial was a randomized control trial involving 508 patients, which aimed to analyze the effect of sirolimus on HCC recurrence.…”

“…Independent of the criteria selection, a combination of immunosuppressants and mTOR inhibitors may be considered to reduce HCC recurrence after LT [ 74 ]. mTOR inhibitors such as sirolimus are known to have anticancer effects, whereas calcineurin inhibitors can promote cancer growth [ 75 , 76 ].…”

Sorafenib versus nivolumab after lenvatinib treatment failure in patients with advanced hepatocellular carcinoma

“…In addition, the different distances between the patients' residences and the two institutes in our study, both of which were located in the South Korean capital of Seoul, might have influenced the choice of second-line agents with different routes of drug administration (1-2 months for oral vs. every 2 weeks for There was no statistical difference between the treatment groups (P = 0.723). intravenous) [29]. Despite this limitation, the findings of this retrospective cohort study in a real-world setting are likely valuable in guiding the design of future prospective studies comparing these two agents.…”

“…Patients who experienced serious adverse events, such as hand-foot-skin reaction, hypertension or proteinuria, during lenvatinib treatment might prefer nivolumab rather than sorafenib [26–28]. In addition, the different distances between the patients’ residences and the two institutes in our study, both of which were located in the South Korean capital of Seoul, might have influenced the choice of second-line agents with different routes of drug administration (1–2 months for oral vs. every 2 weeks for intravenous) [29]. Despite this limitation, the findings of this retrospective cohort study in a real-world setting are likely valuable in guiding the design of future prospective studies comparing these two agents.…”

Delayed Hepatocellular Carcinoma Recurrence After Liver Transplantation: Comprehensive Clinical Characterization of Case Series

“…Because of the tendency toward distal metastases, the American Association for the Study of Liver Diseases (AASLD) guidelines currently recommend chest and abdominal CT scans. 27,28 Additionally, elevated serum AFP levels correlate with HCC recurrence, independent of the timing or location of the recurrence. 29 However, the intensity of surveillance and the optimal timing and duration are uncertain.…”