Liver transplantation (LT) is indicated in cirrhotic patients with early, unresectable hepatocellular carcinoma (HCC). Post-transplant HCC recurrence, although uncommon, remains a serious problem. There are no evidence-based guidelines for surveillance for HCC recurrence after liver transplantation.
Methods: We retrospectively reviewed our experience with LT for HCC during the MELD era, focusing on patients that developed HCC recurrence. The risk factors identified to be predictive of recurrence and the clinical characteristics of recurrence were used to generate surveillance guidelines.
Results: Between March 2002 and December 2010, 275 adults underwent primary LT for HCC, including 53 found to have incidental tumors. The 5-year recurrence-free survival was 82.4% (median follow-up, 44 months). Forty-four patients developed recurrent HCC. An elevated pre-transplant AFP or unfavorable explant pathology (pathologic stage beyond the Milan criteria, poor degree of differentiation, and/or presence of lymphovascular invasion) were associated with recurrence. Nine patients (20%) that recurred had none of these risk factors. Five patients (9%) with incidental tumors recurred. The median time to recurrence was 24.9 months, with lymphovascular invasion (LVI) predicting earlier recurrence. Sixteen patients (36%) recurred after 3 years; 8 (18%) after 5 years. The most common sites of recurrence included the liver (32%) and the lung(s) (27%). AFP was elevated (>50 ng/ml) at the time of recurrence in 26 patients. Median survival after recurrence was 10 months (n=44). Twenty-one patients with recurrent HCC amenable to resection or locoregional therapy experienced improved survival (median survival after recurrence, 19 months, p<0.001).
Conclusions: Surveillance for HCC recurrence is warranted, even for those patients considered low risk for recurrence. Surveillance should include chest and abdominal imaging, and it should be more rigorous for patients with explant LVI. Surveillance should be continued beyond 3 years post-transplant. AFP monitoring is a useful adjunct. Early detection and treatment of localized HCC recurrence may afford longer survival.
To cite this abstract in AMA style:Levi D, Russo M, Uchida K, Nishida S, Tzakis A. Proposed Surveillance Strategy for Hepatocellular Carcinoma Recurrence after Liver Transplantation, A [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/proposed-surveillance-strategy-for-hepatocellular-carcinoma-recurrence-after-liver-transplantation-a/. Accessed December 1, 2023.
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