AIM: To study the impact of locoregional treatment and waiting time before liver transplantation for hepatocellular carcinoma (HCC)

METHODS: A retrospective review of 104 HCC patients undergoing liver transplantation from 2005 and 2011. Time-to-event analysis was used to summarize oncological outcomes in terms of HCC recurrence and HCC-specific mortality. Multivariate Cox proportional hazard regression models were used to evaluate the effects of locoregional treatment, waiting time, transplant eras, Milan criteria and other potential risk factors on each outcome. Kaplan-Meier survival analyses of outcome at 1, 2, 3, 4 and 5 years were evaluated.

RESULTS: Neither waiting time nor locoregional treatment was independently associated with outcomes. Pathology results showed 24 out of 104 patients (23.1%) out of Milan criteria at the time of transplant. Pretransplant alphafetoprotein (AFP) level greater than 10 ng/dL statistically increased the risk of HCC recurrence (Relative Risk [RR] 1.01, p 0.033) and HCC-specific mortality (RR 1.02, p 0.01). HCC-specific mortality was statistically lower in the early era (RR 0.14, p 0.046). Patients with tumors outside Milan criteria at transplant had statistically similar outcomes for HCC recurrence (RR 1.41, p 0.651) and HCC-specific mortality (RR 1.19, p 0.85).

CONCLUSION: The current score system used to allocate livers for transplantation in HCC patients has no deleterious effect on cancer outcomes despite increased waiting time and locoregional treatment. Although complete longer term outcomes are not available, 5 year results indicate that progression beyond Milan criteria at transplant was unrelated to oncological outcomes with increased waiting time.

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