Recurrence of Hepatocellular Carcinoma Following Liver Transplantation

Abstract

Liver transplantation is a viable treatment option for select patients with HCC and end-stage liver disease. However, in approximately 20% of patients, recurrent HCC is the rate-limiting factor for long-term survival. Despite identification of clinical parameters that may stratify patients at high risk and exhaustive preoperative staging, cancer recurrence is likely the result of microscopic extrahepatic disease. With a desperate donor organ shortage, locoregional ablation techniques and resection are being employed in patients on the waiting list to serve as a bridge to OLT. Furthermore, some have advocated aggressive surgical resection of isolated metastasis in both the liver and extrahepatic viscera. Whether these creative strategies confer a survival advantage is unknown; it will require long-term follow-up to determine their efficacy.

Yes-Associated Protein Expression is a Predictive Marker for Recurrence of Hepatocellular Carcinoma after Liver Transplantation

“…With liver transplantation development in recent years, the 5-year survival rate is significantly improved [2]. However, recurrence and metastasis of HCC after LT remains a formidable problem; several large centers have reported that the recurrence rate was approximately 20%, which is the rate-limiting factor for long-term survival [3]. So currently, prevention and treatment of tumor recurrence is one of the hot issues for the research for HCC patients after liver transplantation.…”

An immune function assay predicts post-transplant recurrence in patients with hepatocellular carcinoma

“…Although a variety of studies have demonstrated that the 5-year survival for HCC patients after liver transplantation is approximately 70%, tumor recurrence after transplantation is the rate-limiting factor to achieving long-term survival. The actual incidence of HCC recurrence after transplantation has been reported to vary from 6.4 to 56.5%; survival is significantly lower in patients with recurrence (Zimmerman et al 2008). Several clinicopathological variables such as vascular invasion, lymph node metastasis, tumor size larger than 5 cm, bilobar involvement, and multiple tumor nodules have been identified as important prognostic factors for both tumor recurrence and survival.…”

The Onset of de novo Hepatocellular Carcinoma after Liver Transplantation can be both of Donor and Recipient origin. A Case Report

“…A recurrent HCC should be considered a metastasis of the original tumor reflecting a systemic dissemination of the tumor; those patients may benefit from all surgical, medical or radiological treatments for the HCC, as in the pre-transplant setting, but re-transplantation is contraindicated and the prognosis is really poor, with about 22% chance of survival at 5 years, with a median of less than one year after diagnosis [3,10,11]. Conversely, the development of a de novo HCC can allow even re-transplantation, such was the case in our first patient.…”

“…Recurrence of HCC usually develops early after LT and is strictly dependent on tumor grading and presence of microvascular invasion [2,3]. In addition, LT recipients are exposed to a higher risk of developing other de novo malignancies as a consequence…”