Early Versus Late Hepatocellular Carcinoma Recurrence After Transplantation: Predictive Factors, Patterns, and Long-term Outcome. Issue 8 (20th July 2021)

• Record Type: Journal Article
• Authors: El-domiaty, Nada; Saliba, Faouzi; Vibert, Eric; Karam, Vincent; Sobesky, Rodolphe; Ibrahim, Wafaa; Pittau, Gabriella; Ciacio, Oriana; Salloum, Chady; Amer, Khaled; Saeed, Maysaa A.; Shawky, Jihan A.; Sa Cunha, Antonio; Rosmorduc, Olivier; Cherqui, Daniel; Adam, René; Samuel, Didier
• Is Part Of: Transplantation. Volume 105:Issue 8(2021)
• Page Start: 1778
• Page End: 1790
• Publication Date: 2021-07-20
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000003434
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : Background: Hepatocellular carcinoma (HCC) is currently the first indication of liver transplantation (LT) in Europe and Asia-Pacific region and the third in the United States. HCC recurrence is the main complication affecting short- and medium-term outcomes after LT. Methods: A total of 433 consecutive adult recipients transplanted for HCC between 2000 and 2017 (mean age: 57.8 ± 8.5 y; 83.8% were males) with a mean follow-up of 74.6 ± 58.6 months were included. Patients had to meet Milan criteria and, since 2014, alpha-fetoprotein score to be listed. Patients with HCC recurrence were classified into early (≤2 y) and late recurrence (>2 y) and were retrospectively reviewed. Results: Patients who developed recurrence (75 patients, 17%) had more tumors outside Milan and University of California San Francisco criteria, high alpha-fetoprotein score, and microvascular invasion at pathology. Early recurrence developed in 46 patients (61.3%); the overall 5- and 10-year survival rates of these patients from time of LT were 6.7% and 0%, which were significantly lower than those with late recurrence 64.0% and 27.1%, respectively ( P < 0.001). The median survival times from the diagnosis of HCC recurrence were 15 and 17 months, respectively, in the 2 groups ( P < 0.001). Multivariable Cox regression analysis identified alcoholic cirrhosis as etiology of the underlying liver disease (hazard ratio [HR] = 3.074; P = 0.007), bilobar tumor at time of LT (HR = 2.001; P = 0.037), and a tumor size (>50 mm) in the explant (HR = 1.277; P = 0.045) as independent predictors of early recurrence. Conclusions: Improving the prediction of early HCC recurrence could optimize patient selection for LT, potential adjuvant therapy with new targeted drugs and hence, improve long-term survival.