Risk factors predicting hepatocellular carcinoma recurrence after liver transplantation

Abstract EN

Background: Liver transplantation (LT) has been the standard therapy for patients with HCC within Milan criteria on top of liver cirrhosis.

Tumor recurrence rate (15%) is still a major concern.

The implementation of reliable prognostic parameters of tumor biology into selection process prior to LT is mandatory.

Furthermore, a multidisciplinary approach of pre, intraoperative, and post transplant modulation of the tumor and/or the patient has to be established for improving prognosis in this special subset of patients.

Aim of the study: We analyze the most important risk factors predicting tumor recurrence after liver transplant.

We consider also adding biological criteria of the tumor to the morphological ones in the selection process of the tumors candidate for transplantation.

Methods: A retrospective study included 298 HCC patients who underwent liver transplantation at Cleveland Clinic Foundation between 2000 and 2011.

Pre, postoperative data collected.

Primary end point was tumor recurrence and secondary one was patient survival.

Results: Kaplan-Meier test revealed that overall survival rate was 91.8%, 80.5%, 74.4% at lyear, 3 years and 5 years respectively.

Cox regression analysis showed that the most single important factor affecting the patient survival was the recurrence.

Univariate analysis shows that Milan criteria, AFP value, tumor size, vascular invasion and degree of differentiation were among significant predictors of tumor recurrence (p value < 0.05).

In subgroup of patients within Milan and had alpha-fetoprotein (AFP) value less than 200 ng/dl, recurrence rate was 6.8% in compared to 33.3% in others who had AFP value more than 200 ng/dl with significant p value (0.02).

Conclusion: Strict application of Milan criteria, AFP level, vascular invasion and degree of differentiation are the most important predictors of tumor recurrence after transplant.

Addition of biological factors of the tumor to morphological ones has better outcome as regard patient survival and tumor recurrence