Recurrence of hepatocellular carcinoma after living donor liver transplantation: what is the current optimal approach to prevent recurrence?

Abstract

Liver transplantation plays an important role in the multimodal treatment options for patients with hepatocellular carcinoma (HCC). However, there has been little information about the prognosis for HCC recurrence after living donor liver transplantation (LDLT). We retrospectively analyzed 164 HCC patients who underwent LDLT at our institution between February 1999 and March 2009. In all, 23 of 164 liver recipients developed HCC recurrence 1 to 44 months (median 8 months) after LDLT. The 5-year survival was significantly lower for patients with recurrence than for patients without recurrence (14 vs. 82%; p<0.0001). The 3-year survival was significantly lower for patients with early recurrence (≤1 year) than for patients with late recurrence (>1 year) (8 vs. 40%; p=0.0082). Concerning sites of first tumor recurrence, the 3-year survival rate in patients with recurrence in the graft liver was significantly higher than that of patients with recurrence to other organs (50 vs. 17%, respectively; p=0.0421). As the prognosis of patients with HCC recurrence is quite poor, currently the optimal method of preventing HCC recurrence would be the use of appropriate criteria to select candidates for LDLT.