Purpose: For living-donor liver transplantation (LDLT), there has been a tendency to accept extended criteria in comparison with deceased-donor liver transplantation (DDLT). However, HCC recurrence remains an important problem, and studies regarding the clinical outcomes and treatments of patients with HCC recurrence after LDLT are rare.

Methods: From January 2001 to June 2014, 293 patients underwent LDLT for HCC at our transplant center. Among them, 54 (18.4%) patients experienced HCC recurrence after LDLT. We evaluated patterns and outcomes of HCC recurrence after LDLT, with particular attention to the Milan criteria at transplantation, treatments for HCC-recurrent patients, and factors related to survival after HCC recurrence. Furthermore, we evaluated the efficacy of combination treatment with sorafenib and an mTOR inhibitor.

Results: The 1-, 2-, and 3-year overall survival rates after HCC recurrence were 41.1, 20.5, and 15.4%, respectively. Although recurrence rates according to the Milan criteria at LDLT were significantly different, the time interval between LDLT and HCC recurrence (p = 0.157), the number of HCC recurrences (p = 0.735), and recurrence sites (p = 0.555) were not significantly different between meeting the Milan criteria and those not meeting them at LDLT. Furthermore, survival rates after HCC recurrence were not significantly different between the two groups (p = 0.245). Time to recurrence <12 months (p = 0.048), multiple recurrences at HCC recurrence (p = 0.038), and palliative treatment for recurrent tumors (p = 0.003) were significant independent prognostic factors for poor survival after HCC recurrence in a multivariate analysis. The combination treatment of sorafenib and sirolimus showed survival benefits in the palliative treatment group (p = 0.005).

Conclusion: Satisfying the Milan criteria at LDLT was important for recurrence rates after LDLT, but was not important for survival rates after HCC recurrence. Curative treatment for recurrent HCC after LDLT is the most important factor in survival rates after HCC recurrence. Combination treatments of sorafenib and an mTOR inhibitor could have survival benefits in patients with HCC recurrence after LT in the palliative treatment group. Further prospective studies with larger cohorts are required.

CITATION INFORMATION: Kim D, Na G, Hong T, You Y. Clinical Analysis of Patients with Hepatocellular Carcinoma Recurrence After Living-Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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