Management of Recurrent Hepatocellular Carcinoma after Liver Transplant - A Single Center Experience

Background: Hepatocellular carcinoma (HCC) recurs in 10-60% of patients after liver transplantation and carries very dismal prognosis. Optimal management of this condition has yet to be defined. Patients and Methods: All adult patients with HCC within the UCSF (University of California, San Francisco) criteria who underwent liver transplantation at Queen Mary Hospital during the period from July 1995 to September 2013 were reviewed. Two hundred and fifty-two patients were included in the analysis. They were divided into three groups for comparison: with intrahepatic recurrence (IR), with multiple or extrahepatic recurrence (MR), with no recurrence (NR). Results: HCC recurrence occurred in 35 (13.9%) patients, 3 with IR and 32 with MR. Patients in the IR and MR groups had a younger age (51 vs. 51 vs. 56 years; p=0.007), a higher pretransplant serum a-fetoprotein level (27 vs. 97.5 vs. 18 ng/mL; p=0.005), more tumor nodules (4 vs. 2 vs. 1; p=0.003) and a higher incidence of lymphovascular permeation (33% vs. 59% vs. 27%; p=0.001) than patients in the NR group. More patients in the IR and MR groups had tumors beyond the UCSF criteria on histopathology (67% vs. 56% vs. 17%) when compared with the NR group. Treatments for IR included hepatectomy, radiofrequency ablation and transarterial chemoembolization. One patient with IR remained alive 3 years after last treatment. Overall survival in the IR group was longer than that in the MR group (59 vs. 30.4 months; p<0.001). Time from transplant to recurrence was similar between the two groups (23.1 vs. 12 months; p=0.141). Conclusions: Recurrence of HCC after liver transplantation is not uncommon. Aggressive surgical treatment may prolong survival in patients with IR only. Prognosis for patients with MR is dismal. Effective systemic therapy is urgently needed.