Objective) Salvage liver transplantation (LT) is considered a feasible option for treatment of recurrent hepatocellular carcinoma (HCC), especially when living-donor LT is a possible option. We performed this multicenter study to assess the risk factors associated with recurrence of HCC and patient survival after salvage LT, focusing on the influence of the primary tumor biology.
Methods) Between January 2000 and December 2011, 101 patients who had previously received liver resection (LR) for HCC underwent LT in 3 transplant centers in Korea. After excluding 19 patients due to incomplete data collection and operative mortality, 82 patients data were retrospectively reviewed for analysis.
Results) Thirty-three patients had recurrence of HCC during a median follow-up period of 27 months (range 2∼189 months) after salvage LT. There were 29 deaths, 15 due to HCC recurrence. 5-year survival was 62%. The following factors were associated with reduced recurrence-free survival after salvage LT in univariate analysis: microvascular invasion (p=0.003) and T2 or T3 stage (p=0.016) of the HCC at primary LR, HCC recurrence within 12 months after LR (p<0.001), microvascular invasion (p<0.001) and T2 or T3 stage (p<0.001) of the HCC at the time of LT, cause of salvage LT (HCC recurrence vs. cirrhosis progression, p=0.047), locoregional treatment prior to LT (p=0.028), and Milan criteria (within vs. outside, p<0.001). In multivariate analysis, HCC recurrence within 12 months after LR (HR 3.235, p=0.004) and HCC outside of the Milan criteria at salvage LT (HR 6.064, p<0.001) were significant risk factors for poor recurrence-free survival after salvage LT.
Conclusion) HCC recurrence within 12 months after LR and LT for HCC recurrence outside of the Milan criteria were significantly associated with poor recurrence-free survival following salvage LT. We have shown, through this multicenter analysis, that the pattern of recurrence of HCC following primary LR plays a role in the outcome after salvage LT.
To cite this abstract in AMA style:Lee S, Kwon C, Yang S, Park H, Cho W, Kim J, Park J, Kim S, Joh J, Kim B, Wang H, Lee K, Suh K, Lee S. Early Recurrence of Hepatocellular Carcinoma after Primary Liver Resection Is Associated with Poor Outcome of Salvage Liver Transplantation: A Multicenter Analysis of 82 Cases [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/early-recurrence-of-hepatocellular-carcinoma-after-primary-liver-resection-is-associated-with-poor-outcome-of-salvage-liver-transplantation-a-multicenter-analysis-of-82-cases/. Accessed December 5, 2020.
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