Purpose: Hepatitis C infection (HCV) related-cirrhosis can lead to hepatocellular carcinoma (HCC). Liver transplantation (LT) is the optimal treatment for selected patients with HCC, providing >80% 4-year survival for patients within Milan criteria. We aimed to examine the impact of HCV on HCC recurrence and survival after LT.

Methods: We retrospectively reviewed 202 patients after LT for HCC from 2002-2012 with pre-LT CT or MRI imaging showing tumor within Milan criteria. Data was current until 6/2014. 126 patients had HCV. Pre-LT ablative therapies included transarterial chemoembolization and radiofrequency ablation. Explant pathology confirmed the presence of HCC. A standardized institutional immunosuppression (IS) protocol was employed, being the same for HCV and non-HCV patients in the first four months after LT. Groups were compared with descriptive statistics and unpaired t-testing. Statistical significance was defined as p<0.05.

Results: The Table summarizes demographic, transplant, tumor, and survival data for HCV and non-HCV groups. The HCC recurrence rate in patients with HCV was 7.9%, compared with 21% in the non-HCV group. 13.2% (10 patients) of the non-HCV group had chronic hepatitis B, of which 3 had recurrent HCC. 65.9% of explant livers in the HCV group were within Milan criteria compared with 78.8% in the non-HCV. The presence or absence of pre-LT ablation therapy, MELD scores, AFP, use of donor after cardiac death grafts (DCD), graft survival, and overall survival were similar between groups. Differences in age and HCC recurrence rates were statistically significant.

Conclusion: In our cohort of patients with LT for HCC within Milan criteria, HCV was associated with less HCC recurrence. There was no statistically significant difference in rates of explant HCC outside Milan criteria. While patients with HCV were younger, both groups had similar rates of pre-LT ablation, biological MELD at LT, and DCD rates. Further investigation is needed to determine if IS management differed >4 months post-LT because of HCV, contributing to less HCC recurrence.

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