Objectives: To examine the prognostic features and outcomes of patients undergoing transplantation for hepatocellular carcinoma (HCC).

Methods: A single-institution retrospective chart review was performed on all patients who underwent transplantation (OLT) for HCC between 1990-2014. Clinical data were abstracted and statistical analyses were conducted in standard fashion.

Results: 716 patients underwent OLT for HCC, of which 117 patients developed recurrence. The median follow up of survivors was 59.8 (1.2-166) months. Recurrences were frequently intrahepatic (42%), associated with multiple tumors (58%) and occurred during the first two years after OLT (64%). Overall, the 5-year recurrence rate after OLT was 17%. Factors associated with recurrence after OLT were age > 50 years (p=0.001), multinodularity and tumor > 3 cm at diagnosis (p<0.001), AFP > 400 ng/ml at diagnosis (p=0.004), number of locoregional therapies (>1) prior to OLT (p=0.01), ineffectiveness of treatment (p=0.006), tumors outside Milan criteria (0.002), grade of tumor (poor) (p<0,001), vascular invasion (<0.001), and tumor viability (>3 cm) on pathology (p<0.001). Overall, the 5-year survival rate after OLT was 70%. Factors associated with poor survival were diameter of viable tumor on pathology > 3 cm (p=0.031), vascular invasion (0.001), extrahepatic recurrence (p<0.001), time to recurrence <2 years (p=0.001), and treatment of recurrence (p<0.001). Repeat resection was offered in 40% of patients.

Conclusion: Recurrence can be expected to occur in 17% at 5 years. Predictors of survival and recurrence after OLT are multifactorial. In patients with recurrence, the optimal treatment will predict outcome.

CITATION INFORMATION: Tabrizian P, Nakazawa K, Prigoff J, Schwartz M, Florman S. Outcomes Following Transplantation for Hepatocellular Carcinoma. Am J Transplant. 2017;17 (suppl 3).

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