Background: Whether primary liver transplantation (PLT) is superior to the upfront hepatic resection (HR) and salvage liver transplantation (SLT) for hepatocellular carcinoma (HCC) within Milan criteria is debatable.

Aim of study: This retrospective study aims to compare the long-term survival rates of patients with HCC within Milan criteria undergoing PLT with those undergoing HR + SLT.

Patients and methods: Patients with HCC within Milan criteria underwent PLT (n = 149) or HR + SLT (n = 26) were analyzed retrospectively from a prospective database. Patients' demographic characteristics, short-term and long-term outcome measures were compared between 2 groups. Multivariate analyses were carried out to identify independent significant prognostic factors affecting patients' survival.

Results: Patients' demographic characteristics and tumor status were comparable between 2 groups in terms of age, sex ratio, proportions of patients with hepatitis B or C infection, tumor number and size and microvascular invasion of tumor. PLT group has significantly higher MELD (Model of End-stage Liver Disease) score than HR + SLT group. More patients in HR + SLT group (80.7%) received living donor liver transplantation than those in PLT group (61.7%). Proportion of patients with severe postoperative complications was comparable between groups. Patients in HR + SLT group had significant shorter hospital stay than PLT group. With median follow-up of 55 months, overall tumor recurrence rate was lower in PLT group (7.9%) than HR + SLT group (26.9%). The 1-year, 3-year and 5-year overall survival rates for PLT group and HR + SLT group were 96%, 89.9%, 96.7% and 100%, 92.3%, 76.9%, respectively. (P = 0.110) On multivariate analysis, Preoperative serum alpha fetoprotein level and microvascular tumor invasion were independent poor prognostic factors for overall survival.

Conclusion: Both PLT and HR + SLT are effective treatment modalities for early stage HCC in terms of similar overall survival rate. However, tumor recurrence is significant high in HR + SLT group. Better patient selection in terms of those with favorable tumor characteristics is warrant in patients undergoing SLT for recurrent HCC.

CITATION INFORMATION: Ng K, Chok K, Chan A, Wong T, Fung J, Lo C.-M. Comparison of Long-Term Survival Outcome Between Primary Liver Transplantation and Hepatic Resection with Consequent Salvage Transplantation for Hepatocellular Carcinoma within Milan Criteria – A Single-Center Experience. Am J Transplant. 2017;17 (suppl 3).

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