Extremes of Liver Transplantation for Hepatocellular Carcinoma

• Main Authors: Michał Grąt, Maciej Krasnodębski, Marek Krawczyk, Jan Stypułkowski, Marcin Morawski, Michał Wasilewicz, Zbigniew Lewandowski, Karolina Grąt, Waldemar Patkowski, Krzysztof Zieniewicz
• Format: Article
• Language: English
• Published: MDPI AG 2019-06-01
• Series: Journal of Clinical Medicine
• Subjects: hepatocellular carcinoma; liver transplantation; alpha-fetoprotein; tumor recurrence
• Online Access: https://www.mdpi.com/2077-0383/8/6/787

The aim of this retrospective observational study was to evaluate outcomes of patients with extremely advanced hepatocellular carcinoma (HCC) after liver transplantation. A total of 285 HCC patients after liver transplantation were screened for eligibility based on either intrahepatic dissemination (&#8805;10 tumors) or macrovascular invasion. Tumor recurrence was the primary end-point. The study cohort comprised 26 patients. Median recurrence-free survival was 23.2 months with hepatitis B virus (HBV) infection (<i>p</i> = 0.038), higher AFP model score (<i>p</i> = 0.001), prolonged graft ischemia (<i>p</i> = 0.004), and younger donor age (<i>p</i> = 0.016) being significant risk factors. Median recurrence-free survival of HBV-negative and HBV-positive patients was 29.8 and 9.3 months, respectively (<i>p</i> = 0.053). In patients with macrovascular invasion, recurrence-free survival at 3 years was 46.3% with no specific predictors. Tumor size (<i>p</i> = 0.044), higher AFP model score (<i>p</i> = 0.019), prolonged graft ischemia (<i>p</i> = 0.016), and younger donor age (<i>p</i> = 0.041) were significant risk factors in patients with intrahepatic dissemination. Superior 3-year outcomes were observed in patients with intrahepatic dissemination and tumor size &lt;3.5 cm (83.3%, <i>p</i> = 0.027) and HBV-negative patients with ischemia &lt;9.7 h (85.7%, <i>p</i> = 0.028). In conclusion, patients with extremely advanced HCCs are remarkably heterogeneous with respect to their profile of tumor recurrence risk. This heterogeneity is largely driven by factors other than standard predictors of post-transplant HCC recurrence.