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

Abstract

Aim: We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular carcinoma recurrence. Methods: We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015. Results: In total, 88% of recipients were males. The mean age was 59 years. On explant, poor differentiation was detected in 43%, while 73% had microvascular invasion. Overall, 62% were diagnosed to be outside of Milan criteria. Out of these, 15% met the criteria for downstaging. Twenty (77%) patients had pre-transplant alpha fetoprotein levels ≥ 20 ng/mL. In 54% of patients, the location of hepatocellular carcinoma (HCC) recurrence was extrahepatic, followed by intrahepatic in 31% and both intra-and extrahepatic in 15%. The post-transplant tumor recurrence was diagnosed at a mean of 427 days (range 34-1502). Fifty percent of HCC recurrences were diagnosed within one year following liver transplant. Twenty (77%) patients received treatment for their recurrent HCC: external radiation (n = 10), surgical resections (n = 8; brain 4, spine 2, bone 1, and Whipple surgery 1), sorafenib (n = 7), locoregional therapy (n = 5). Overall, 24 out of 26 (92%) recipients died within four years after the transplant. Conclusion: HCC recurrence after liver transplant is infrequent. More than fifty percent of HCC recurrences following liver transplant are extrahepatic. Despite better recipient selection for liver transplant, the curative options are limited in recurrent cases and associated with extremely poor outcomes.

Hepatocellular Carcinoma and the Role of Liver Transplantation: A Review

“…A recent case series showed that approximately one-third of patients were within MC on explant pathology when they were all within MC according to imaging findings. 111 Other factors such as vascular invasion, degree of tumor differentiation, tumor stage and AFP levels also play an important role in recurrence. The OS after HCC recurrence is approximately 1 year.…”

“…At our center, postoperative HCC surveillance usually consists of contrasted cross-sectional imaging with CT or MRI with AFP measurement every 3 months for the first year and every 6 months for the second and third years. 111 …”