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Recurrence of hepatocellular carcinoma after liver transplantation: Is there a place for resection?

Research paper by Elena E Fernandez-Sevilla, Marc-Antoine MA Allard, Jasmijn J Selten, Nicolas N Golse, Eric E Vibert, Antonio A Sa Cunha, Daniel D Cherqui, Castaing C Denis, René R Adam

Indexed on: 12 Feb '17Published on: 12 Feb '17Published in: Liver Transplantation



Abstract

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is widely considered as a terminal condition. Therefore, the role of surgery is uncertain in this case. The purpose of this study was to identify the prognostic factors of survival after post-LT HCC recurrence and evaluate the impact of surgery in this setting.All patients transplanted for HCC between 1991 and 2013 in a single institution and who further developed a post-LT recurrence were included in this study. Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Of the 493 patients transplanted for HCC, a total of 70 (14.2%) consecutive patients developed a recurrence after a median disease-free interval of 17 months. Median survival from the time of recurrence was 19 months, with a 3-year post-recurrence survival of 26%. Most recurrences were extrahepatic (lung, lymph node and bone) (n=51; 72.9%), whereas only intrahepatic recurrences were observed in 2 patients (2.8%). Both intrahepatic and extrahepatic locations were found in 17 patients (24.3%). A total of 22 patients (31.4%) underwent macroscopically complete resection of the recurrence (intrahepatic, n=2 and extrahepatic, n=20). The median survival for resected patients after transplantation was 35 months compared to 15 months for non-resected patients (P <0.001). In multivariate analysis, the independent unfavorable factors of post-recurrence survival were AFP level > 100 ng/ml at relapse (HR 2.09 [1.07-4.06], P =0.03), intrahepatic location (HR 1.80 [1.01-3.21], P =0.048), and multifocal recurrence (HR 1.79 [1.02-3.11], P =0.04). The management including surgery (HR 0.36 [0.18-0.73], P =0.004) was identified as an independent favorable factor.Recurrence of HCC after liver transplantation is associated with a poor prognosis. However, resection is associated with improved survival and should, therefore, be considered when feasible. This article is protected by copyright. All rights reserved.