A National Survey of Hepatocellular Carcinoma Surveillance Practices Following Liver Transplantation

Abstract

Background. Recurrence of hepatocellular carcinoma (HCC) is an important predictor of survival after liver transplantation (LT). Recent studies show that early diagnosis, aggressive treatment, and surveillance may improve outcomes after HCC recurrence. We sought to determine the current practices and policies regarding surveillance for HCC recurrence after LT. Methods. We conducted a web-based national survey of adult liver transplant centers in the United States to capture center-specific details of HCC surveillance post-LT. Responses were analyzed to generate numerical and graphical summaries. Results. Of 101 eligible adult liver transplant centers, 48 (48%) centers across the United States responded to the survey. Among the participating centers, 79% stratified transplant recipients for HCC recurrence risk, while 19% did not have any risk stratification protocol. Explant microvascular invasion (mVI) was the most common factor used in risk stratification. Use of pretransplant serum biomarkers such as alpha-fetoprotein (AFP) was variable, with only 48% of the participating centers reporting specific “cutoff” values. While a majority of centers (88%) reported having a routine imaging protocol for HCC recurrence surveillance, there was considerable heterogeneity in terms of frequency and duration of such surveillance. Of the centers that did risk stratify patients to identify those at higher risk of HCC recurrence, about 50% did not change their surveillance protocol. Conclusions. Our study affirms significant variability in center practices, and our results reflect the need for high-quality studies to guide risk stratification and surveillance for HCC recurrence.

R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation

“…These results strongly support the need for personalized post-LT HCC screening procedures based on individual risk of HCC recurrence. There is currently no consensus on post-LT surveillance strategies and a recent study from the United States showed surveillance strategies remain highly heterogeneous across US centers (35). Also, some centers do not screen for HCC recurrence due to concerns on cost-effectiveness.…”

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

“…Late recurrences happen at between 2 and 5 years. A recurrence after 5 years is rare [ 18 ]. They concern the liver (from 27% to 45%), but more frequently they appear in other locations (around 60%), mainly in lungs and bones, and less often in the adrenal glands, peritoneum, and lymph nodes [ 7 , 18 , 91 , 121 – 123 ].…”

Revisiting Surgical Strategies for Hepatocellular Carcinoma With Microvascular Invasion

“…A meta-analysis of 2003 HCC patients who underwent LT indicated that MVI was related to 2.3-fold decrease of 5-year OS rate compared with those without MVI ( 6 ). Therefore, MVI was the most common factor used in risk stratification and surveillance for HCC recurrence after LT ( 65 ). Bhatti et al.…”