Korean J Transplant.  2023 Nov;37(Suppl 1):S122. 10.4285/ATW2023.F-7052.

Predictors of postrecurrence survival in hepatocellular carcinoma patients after living donor liver transplantation

• Choi MH
• Hwang S
• Ahn CS
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Yoon YI
• Kang WH

• KMID: 2551742
• DOI: http://doi.org/10.4285/ATW2023.F-7052

Abstract

Background
The prognosis of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) has been poor despite active recurrence treatment and mammalian target of rapamycin (mTOR) inhibitor administration. The present study evaluated the postrecurrence survival after LT to assess its prognostic predictors.
Methods
This retrospective observational study evaluated postrecurrence survival in 115 patients who underwent living donor LT (LDLT) for HCC during 10 years between 2006 and 2015 at Asan Medical Center.
Results
Posttransplant follow-up up to 15 years, 100 of 115 patients had died due to HCC recurrence. The median disease-free survival, postrecurrence survival and overall patient survival periods were 10 months, 17 months and 32 months, respectively. Univariate analysis revealed that HCC recurrence within 12 months after LT (P<0.001), ADV score >5 log (P=0.019), mTOR inhibitor administration (P=0.031) were statistically significant risk factors, but Milan criteria (P=0.912) was not. In contrast, a combination of ADV score >5 log and beyond Milan criteria showed higher prognostic contrast (P=0.001). Multivariate analysis revealed that HCC recurrence within 12 months after LT (hazard ratio [HR], 3.2; P<0.001) and combination of ADV score >5 log and beyond Milan criteria (HR, 2.3; P=0.009) were significant, but mTOR inhibitor administration (HR, 1.5; P=0.108) was not. In contrast, these three factors were independent risk factors on overall patient survival.
Conclusions
Post-HCC recurrence survival after LDLT are affected by characteristics of tumor biology including early recurrence and high ADV score combined with Milan criteria. Administration of mTOR inhibitor appears to be beneficial to prolonged survival.