Late recurrence of hepatocellular carcinoma after liver transplantation

Abstract

Aims Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide and liver transplant (LT) prolongs survival. However, 15–20% will experience recurrent HCC, most occurring within 2 years of LT. HCC patients with late recurrences (>5 years after LT) may have distinctive clinical/biological characteristics. Methods A retrospective review was conducted of 88 patients who underwent LT for HCC between 1993–2015, analyzing demographics, clinical factors, explant pathology, and outcome. Results Median follow-up was 6.4 years. HCC recurred in 15 (17.0%) patients with mean time to recurrence of 3.96 +/− 3.99 years. Five patients recurred >5 years post-LT. All late recurrences involved males in their 50s, recurring at 8.5 years on average. Recurrences occurred in chest wall (2), liver (2), lung (2), bone (1) and pelvis (1), with multifocal involvement in 2 patients. Four patients died within 18 months of late recurrence. The fifth patient is alive after ablation of liver recurrence and treatment with sorafenib and everolimus. Conclusions One-third of post-LT patients with recurrent HCC experienced late recurrence. Although the sample size makes it difficult to identify significant risk factors, this study highlights the importance of long-term follow up and need for biomarkers to identify patients at risk for late recurrences.

Sex‐specific analysis post‐liver transplantation in hemochromatosis with aplastic anemia and hepatocellular carcinoma

“…The patient had been on stable immunosuppression for many years and had no new concomitant illness. A previous report of late recurrence of HCC (>5 years after transplantation) reported late recurrence in 5.6% of 88 patients, with an average length after recurrence of 8.5 years . The tumor stained positive for hepatocyte‐specific antigen (HepPAR1) (Fig.…”

Recurrence of hepatocellular carcinoma following deceased donor liver transplantation: case series

“…There are a few potential theories for early HCC recurrence post-LT: (1) biologically rapid growing, aggressive tumors; (2) lack of high-quality pre-LT imaging or overlooking intra-or extrahepatic imaging [8] ; (3) extrahepatic microscopic viable HCC cells that could not be detected by conventional imaging prior to LT; and (4) presence of circulating tumor cells that seed to other sites. The mechanism by which the late recurrence occurs is unclear [15] . Presence of pre-LT HCCs that are biologically slow growing, or development of de novo HCC recurrence in the liver allograft could be the cause.…”

Ten-year survival and recurrence of hepatocellular cancer

“…While much of the literature focuses on 5-year outcome, less is reported about longer term survival beyond 5 years. Late recurrence, which occurs after 5 years, has been described in patients after resection or transplant [11][12][13] . Others have suggested that underlying liver function as measured by albumin-bilirubin (ALBI) grade correlated with recurrence free survival [14,15] .…”