Primary Versus Salvage Living Donor Liver Transplantation for Patients With Hepatocellular Carcinoma: Impact of Microvascular Invasion on Survival

Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan

“…[7][8][9][10][11][12][13] SLT has the lowest potential for re-recurrence, with a 5-year DFS rate of 48-67%. 8,11,24 A recent report showed a 5-year DFS rate of 60% after living-donor SLT for recurrent HCC within the Milan criteria. 15 However, a donor-pool shortage, lifelong immunosuppression and the technical demands of the procedure limit its use for all patients.…”

“…Current results showed that SLT had a 5-year DFS rate of 75%; this was significantly better than LA and RR and was comparable to previous reports. 8,11,15,24 However, SLT failed to show the same advantage with regards to OS. Liver transplantation, by nature, is a complex and technically demanding procedure, especially SLT.…”

“…6,7 Different modalities have been used for IHR management, including salvage liver transplantation (SLT), re-resection (RR), local ablation (LA) using radiofrequency ablation (RFA) and/or percutaneous ethanol injection (PEI) and trans-arterial embolization/chemo-embolization (TAE/TACE). [7][8][9][10][11][12][13][14] Currently, there are no definitive selection criteria for IHR management other than those applied to the management of primary HCC. 13,15 The pathological features of HCC and non-tumor liver parenchyma (NTLP) are strongly related to recurrence.…”

2014 KLCSG-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma: HCC Diagnostic Algorithm

“…Therefore, the noninvasive diagnostic criteria of HCC proposed by the AASLD, the EASL-EORTC, the OPTN and the LI-RADS (category 5) were intentionally not optimized to achieve maximum sensitivity for HCC detection, but rather to raise the specificity of an HCC diagnosis [15,17,25]. Conversely in Asia, including Japan and Korea, liver transplantation is mainly used as a salvage operation after applying many treatments such as surgical resection, radiofrequency ablation and transarterial chemoembolization, and more than 70% of liver transplantations in Asia are living donor liver transplantations [143]. …”

Management of “very early” hepatocellular carcinoma on cirrhotic patients

“…This has raised the question if the "ablate and wait" strategy may result in a percentage of patients with recurfrom LT, due to a non-transplantable recurrence, tumor progression during the waiting time or life-threatening complication of underlying cirrhosis, and so, the feasibility of salvage transplantation will be closely related to a strict surveillance after resection and the consequent early diagnosis of intrahepatic recurrence [62] . Although there is conflicting results when comparing primary LT and salvage transplantation and there is a concern on the higher risk of complications in patients that receive a transplant after LR, most studies showed no differences when comparing biliary leaks, vascular complications, re-operation or re-transplantation rates [64,65] . Nevertheless, operative mortality and bleeding have been described to be significantly higher after salvage transplantation in some series [62] .…”