J Korean Med Sci.  2014 Oct;29(10):1360-1366. 10.3346/jkms.2014.29.10.1360.

Optimal Tailored Screening Protocol after Living Donor Liver Transplantation for Hepatocellular Carcinoma

• Park MS
• Lee KW
• Yi NJ
• Choi YR
• Kim H
• Hong G
• Suh KS
• Kwon CH
• Joh JW
• Lee SK

• KMID: 2129625
• DOI: http://doi.org/10.3346/jkms.2014.29.10.1360

Abstract

The indication for hepatocellular carcinoma (HCC) is expanding in living donor liver transplantation (LDLT). Early detection and effective management of recurrence has become an important issue in LDLT for HCC. This study aimed to find an optimal screening protocol in terms of screening interval and screening tools by analyzing recurrence pattern after LDLT for HCC. A total of 205 LDLT patients in two centers from February 1999 to October 2010 was reviewed. Recurrence appeared in 55 cases. Six risk factors for recurrence were identified: preoperative alpha-fetoprotein >400, Edmonson grade 3 or 4, tumor size >7 cm, tumor number > or =7, minimal tumor necrosis in the transarterial chemoembolization group and positive micro-vascular invasion. Four groups with different ranges of index scores showed different recurrence-free survival and median time to recurrence. Group I showed low and late recurrence. Groups II and III showed linearly increased rate of recurrence until 18 months. Group IV showed very early recurrence within 6 months. Across the groups, extra-hepatic recurrence developed in more than 40% of cases and multi-organ recurrence rate was 20%. The screening interval should be different based on the risk of recurrence. Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.

Keyword

Carcinoma; Hepatocellular; Living Donors; Liver Transplantation; Recurrence; Screening

MeSH Terms

Carcinoma, Hepatocellular/pathology/*surgery
Chemoembolization, Therapeutic/adverse effects
Disease-Free Survival
Female
Humans
Liver Neoplasms/pathology/*surgery
*Liver Transplantation
Living Donors
Male
Middle Aged
Neoplasm Recurrence, Local/*pathology
Risk Factors
Treatment Outcome

Figure

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  Fig. 1 Recurrence free survival rate of 205 patients with hepatocellular carcinoma who underwent living donor liver transplantation.

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  Fig. 2 Cumulative recurrence rates according to group based on the risk index. Group I shows very low and late recurrence after 18 months. In groups II and III, most recurrences develop within the first 18 months in a temporally linear manner. Group IV shows an early recurrence pattern within 6 months in most cases.

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  Fig. 3 Recurrence free survival rates according to UCSF criteria. (A) Recurrence free survival rates of patients who met UCSF criteria according to group. (B) Recurrence free survival rates of patients who were outside of UCSF criteria according to group.

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  Fig. 4 Surgical treatment significantly improves the overall survival after tumor recurrence.

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