Salvage Liver Transplantation Leads to Poorer Outcome in Hepatocellular Carcinoma Compared with Primary Liver Transplantation

Shan, Yijun; Huang, Lifeng; Xia, Qiang

doi:10.1038/srep44652

Cited by 17 publications

(18 citation statements)

References 28 publications

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“…While looking at the follow-up period between SLT patients and PLT patients in the included studies we found that there was no significant difference between the 2 groups (SMD: −0.25, 95% CI: −0.56 to 0.05, P =0.10, Figure 4B ) [ 16 – 18 , 22 – 24 , 26 – 31 , 34 – 37 ].…”

Section: Resultsmentioning

confidence: 97%

“…The database search identified 3714 references for assessment ( Figure 1 ) of which 154 full-text articles were assessed for eligibility; of these, 134 articles were excluded (121 did not meet inclusion criteria and 13 had insufficient data). The remaining 20 retrospective studies between 2003 and 2017 were eligible according to our inclusion criteria and were included in this meta-analysis [ 11 , 16 – 18 , 22 – 37 ], with a total of 9879 patients included (SLT=1306 patients and PLT=8573 patients) ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…To assess the outcome measurement of AFP level, a total of 8382 patients were included from 7 studies [ 17 , 18 , 26 , 27 , 30 , 32 , 37 ]. The χ 2 test revealed P =0.002 and I 2 =71%; meta-analysis using a random effect model revealed that SLT had a significantly lower AFP level than that of PLT (SMD: −0.27, 95% CI: −0.51 to −0.04, P =0.02) ( Figure 2B ).…”

Section: Resultsmentioning

confidence: 99%

“…Data was classified according to donor type: DDLT and LDLT. In DDLT recipients, there was no significant difference in 1-year OS rate (OR: 0.93, 95% CI: 0.80 to 1.09, P =0.40, Figure 6A ) [ 16 , 17 , 22 , 24 – 27 , 29 , 30 , 33 , 35 – 37 ] and 3-year OS rate (OR: 0.89, 95% CI: 0.78 to 1.02 , P =0.08, Figure 6B ) [ 16 – 18 , 22 , 24 – 27 , 29 , 30 , 33 , 35 – 37 ] between the SLT group and the PLT group. However, 5-year OS rate was superior in the SLT group compared to the PLT group (OR: 0.81, 95% CI: 0.71 to 0.92, P =0.001, Figure 6C ) [ 16 , 17 , 22 , 24 – 27 , 29 , 30 , 33 , 35 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Since then, several studies have shown SLT is an effective approach for patients with recurrent HCC or crumbling of liver function after LR [ 11 , 16 ]. However, some studies have shown negative results for SLT compared to PLT [ 17 , 18 ], mainly related to surgical difficulties due to adhesions, increased rate of post-transplant complications, and poor long-term outcomes. Thus, SLT remains a controversial approach for many surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma

et al. 2018

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BackgroundThe strategy of salvage liver transplantation (SLT) originated for initially resectable and transplantable hepatocellular carcinoma (HCC) to preclude upfront transplantation, with SLT in the case of recurrence. However, SLT remains a controversial approach in comparison to primary liver transplant (PLT). The aim of our study was to conduct a systemic review and meta-analysis to assess the short-term outcomes, overall survival (OS), and disease-free survival (DFS) between SLT and PLT for patients with HCC, stratifying results according to the Milan criteria and donor types.Material/MethodsA search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing SLT and PLT. A fixed effects model and a random effects model meta-analysis were conducted to assess the short-term outcomes, OS, and DFS based on the evaluation of heterogeneity.ResultsSLT had superior 1-year, 3-year, and 5-year OS and DFS compared with that of PLT. After classifying data according to donor type and Milan criteria, our meta-analysis revealed: that for deceased-donor liver transplantation (DDLT) recipients, there were no significant differences in 1-year and 3-year OS rate between the SLT group and the PLT group. However, the 5-year OS rate was superior in the SLT group compared to the PLT group. Similarly, SLT had superior 1-year, 3-year, and 5-year OS rate compared to PLT in living-donor liver transplantation (LDLT) recipients. Moreover, 1-year, 3-year, and 5-year DFS were also superior in SLT compared to PLT in both the DDLT and LDLT recipients. In patients within Milan criteria there were no statistically significant differences in 1-year, 3-year, and 5-year OS and DFS between the SLT group and the PLT group. Similarly, in patients beyond Milan criteria, both SLT and PLT showed no significant difference for 1-year, 3-year, and 5-year OS rate.ConclusionsOur meta-analysis included the largest number of studies comparing SLT and PLT, and SLT was found to have significantly better OS and DFS. Moreover, this meta-analysis suggests that SLT has comparable postoperative complications to that of PLT, and thus, SLT may be a better treatment strategy for recurrent HCC patients and patients with compensated liver, whenever feasible, considering the severe organ limitation and the safety of SLT. However, PLT can be referred as a treatment strategy for HCC patients with cirrhotic and decompensated liver.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma

et al. 2018

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Defining Optimal Surgical Treatment for Recurrent Hepatocellular Carcinoma: A Propensity Score Matched Analysis

et al. 2018

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Salvage liver transplantation (sLT) and repeated resection (RR) are effective treatments for recurrent hepatocellular carcinoma (HCC), and comparisons of the oncological outcomes between these 2 modalities were scarce. Consecutive patients admitted for either sLT or RR for recurrent HCC were recruited. All patients in the present series received either prior hepatectomy, ablative therapy, or both before RR or sLT. Patient demographic, perioperative, and outcome data were analyzed. A survival analysis was performed after propensity score matching. There were 277 eligible patients recruited, and 67 and 210 of them underwent sLT and RR, respectively. Significant differences in preoperative hemoglobin, albumin, Model of End-Stage Liver Disease (MELD) score, and tumor number were found between the sLT and RR groups. After 1:3 propensity score matching, there were 36 sLT and 108 RR patients for comparison. The median age, MELD, alpha fetoprotein, and tumor size and number of the matched population were 57 years, 7.5, 16 ng/mL, 2.5 cm, and 1, respectively. There was no difference in the hospital mortality and complication rate (Clavien IIIa or above) between the groups. The recurrence rate after RR was significantly higher than for the patients who received sLT (72.2% versus 27.8%; P < 0.001). Following RR, 3 patients received liver transplantation for further recurrence, and 54.6% of the patients developed nontransplantable recurrence. The 5-year disease-free survival (DFS) and overall survival (OS) were both superior in the sLT group (DFS, 71.6% versus 32.8%, P < 0.001; OS, 72.8% versus 48.3%, P = 0.007). In conclusion, sLT is superior to RR for treatment of recurrent HCC in terms of DFS and OS. The high rate of nontransplantable recurrence after reresection underscores the importance of timely sLT.

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Liver Resection Versus Embolization for Recurrent Hepatocellular Carcinoma

et al. 2019

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Background Despite curative resection, hepatocellular carcinoma (HCC) has a high probability of recurrence. We validated the potential role of liver resection (LR) for recurrent HCC. Methods Patients with intrahepatic recurrence with up to three lesions were included. We compared survival times of patients undergoing their first LR to those of patients undergoing repeated LR. Then, survival times of the patients who had undergone LR and transcatheter chemoembolization (TACE) for recurrent HCC after propensity score matching were compared. Results After a median follow‐up period of 3.1 years (range, 0.2–16.3), median overall survival times were 6.5 years (95% CI 6.0–7.0), 5.7 years (5.2–6.2), and 5.1 years (4.9–7.3) for the first LR (n = 1234), second LR (n = 273), and third LR (n = 90) groups, respectively. Severe complications frequently occurred in the first LR group (p = 0.059). Operative times were significantly longer for the third LR group (p = 0.012). After the first recurrence, median survival times after one‐to‐one pair matching were 5.7 years (95% CI 4.5–6.5) and 3.1 years (2.1–3.8) for the second LR group (n = 146) and TACE group (n = 146), respectively (p < 0.001). The median survival time of the third LR group (n = 41) (6.2 years; 95% CI 3.7–NA) was also longer than that of TACE group (n = 41) (3.4 years; 1.8–4.5; p = 0.010) after the second recurrence. Conclusions Repeated LR for recurrent HCC is the procedure of choice if there are three or fewer tumors.

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Salvage Liver Transplantation Leads to Poorer Outcome in Hepatocellular Carcinoma Compared with Primary Liver Transplantation

Cited by 17 publications

References 28 publications

Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma

Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma

Defining Optimal Surgical Treatment for Recurrent Hepatocellular Carcinoma: A Propensity Score Matched Analysis

Liver Resection Versus Embolization for Recurrent Hepatocellular Carcinoma

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