Ann Surg Treat Res.  2018 Sep;95(3):152-160. 10.4174/astr.2018.95.3.152.

Continuing five or more locoregional therapies before living donor salvage liver transplantation for hepatocellular carcinoma is related to poor recurrence-free survival

• Rhu J
• Kim JM
• Choi GS
• Kwon CH
• Joh JW

• KMID: 2419446
• DOI: http://doi.org/10.4174/astr.2018.95.3.152

Abstract

PURPOSE
This study was designed to analyze factors related to the success of salvage liver transplantation (SLT) in hepatocellular carcinoma (HCC). While liver resection (LR) is considered the best locoregional therapy in HCC, there is a high recurrence rate. SLT may be the best treatment option when feasible.
METHODS
Patients who underwent living donor SLT for recurrent HCC after LR from November 1996 to May 2017 were included. Patient demographic data, clinical and pathologic characteristics, operative data, hospital course, and follow-up data regarding initial LR, locoregional therapy after recurrence and SLT were reviewed. Prognostic factors for recurrence were analyzed using Cox proportional hazard ratio.
RESULTS
Eighty-five of 123 SLT patients were included. Patients who had five or more locoregional therapies prior to SLT (hazard ratio [HR], 3.74; 95% confidence interval [CI], 1.45-9.64, P = 0.006), hepatitis B (HR, 9.20; 95% CI, 1.13-74.89; P = 0.04), outside Milan criteria at the time of SLT (HR, 2.66, 95% CI, 1.26-5.63; P = 0.011) and an alpha-fetoprotein level above 1,000 ng/mL at the time of recurrence after initial LR (HR, 6.48; 95% CI, 1.83-22.92; P = 0.004) and at the time of transplantation (HR, 3.43; 95% CI, 1.26-5.63; P = 0.011) were related to significant risk of recurrence.
CONCLUSION
Continuing five or more locoregional therapies for recurrent HCC after LR is related to poor recurrence-free survival after SLT.

Keyword

Hepatocellular carcinoma; Living donor liver transplant

MeSH Terms

alpha-Fetoproteins
Carcinoma, Hepatocellular*
Follow-Up Studies
Hepatitis B
Humans
Liver Transplantation*
Liver*
Living Donors*
Recurrence
alpha-Fetoproteins

Figure

• 

  Fig. 1 A total of 85 patients were included in the study after excluding patients who underwent salvage liver transplantation due to liver failure (n = 26), patients who underwent deceased donor liver transplantation (n = 9) and patients who underwent locoregional therapy more than 6 months prior to liver resection (n = 3). SLT, salvage liver transplantation; LR, liver resection; HCC, hepatocellular carcinoma; LT, liver transplantation; LRT, locoregional therapy.

• 

  Fig. 2 Multivariate Cox analysis showed that patients who underwent 5 or more locoregional therapies prior to salvage liver transplantation (hazard ratio [HR], 3.74; 95% confidence interval [CI], 1.45–9.64, P = 0.006) (A) outside the Milan criteria at the time of transplantation (HR, 2.66, CI, 1.26–5.63, P = 0.011) (B) and α-FP level ≥ 1,000 ng/mL at the time of LT (HR, 3.43, CI, 1.28–9.18, P = 0.014) (C) were significant factors related to recurrence after salvage liver transplantation. HR, hazard ratio; CI, confidence interval; LRT, locoregional therapy; SLT, salvage liver transplantation.

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