Time of hepatocellular carcinoma recurrence after liver resection and alpha-fetoprotein are important prognostic factors for salvage liver transplantation.

Abstract

Salvage liver transplantation (LT) is considered a feasible option for the

treatment of recurrent hepatocellular carcinoma (HCC). We performed this

multicenter study to assess the risk factors associated with the recurrence of

HCC and patient survival after salvage LT. Between January 2000 and December

2011, 101 patients who had previously undergone liver resection (LR) for HCC

underwent LT at 3 transplant centers in Korea. Sixty-nine patients' data were

retrospectively reviewed for the analysis. The recurrence of HCC was diagnosed at

a median of 10.6 months after the initial LR, and patients underwent salvage LT.

Recurrences were within the Milan criteria in 48 cases and were outside the Milan

criteria in 21 cases. After salvage LT, 31 patients had HCC recurrence during a

median follow-up period of 24.5 months. There were 24 deaths, and 20 were due to

HCC recurrence. The 5-year overall survival rate was approximately 54.6%, and the

5-year recurrence-free survival rate was 49.3%. HCC recurrence within the 8

months after LR [hazard ratio (HR) = 3.124, P = 0.009], an alpha-fetoprotein

level higher than 200 ng/mL (HR = 2.609, P = 0.02), and HCC outside the Milan

criteria at salvage LT (HR = 2.219, P = 0.03) were independent risk factors for

poor recurrence-free survival after salvage LT. In conclusion, the timing and

extent of HCC recurrence after primary LR both play significant roles in the

outcome of salvage LT.