Salvage living donor liver transplantation for hepatocellular carcinoma recurrence after hepatectomy: Quantitative prediction using ADV score

Abstract

Background: Salvage liver transplantation is a definite treatment for recurrent hepatocellular carcinoma (HCC) after hepatectomy. ADV score is calculated by multiplying α-fetoprotein and des-γ-carboxyprothrombin concentrations and tumor volume.Prognostic accuracy of ADV score was assessed in patients undergoing salvage living donor liver transplantation (LDLT) and their outcomes were compared with patients undergoing primary LDLT. Methods: This study was a retrospective, single-center, case-controlled study.Outcomes were compared in 125 patients undergoing salvage LDLT from 2007 to 2018 and in 500 propensity score-matched patients undergoing primary LDLT. Results: In patients undergoing salvage LDLT, median intervals between hepatectomy and tumor recurrence, between first HCC diagnosis and salvage LDLT, and between hepatectomy and salvage LDLT were 12.0, 37.2, and 29.3 months, respectively. Disease-free survival (DFS, P = .98) and overall survival (OS, P = .44) rates did not differ significantly in patients undergoing salvage and primary LDLT.Pretransplant and explant ADV scores were significantly predictive of DFS and OS in patients undergoing salvage and primary LDLT (P < .001). DFS after prior hepatectomy (P = .52) and interval between hepatectomy and LDLT (P = .82) did not affect DFS after salvage LDLT. Milan criteria and ADV score were independently prognostic of DFS and OS following salvage LDLT, and prognosis of patients within and beyond Milan criteria could be further stratified by ADV score. Conclusions: Risk factors and posttransplant outcomes were similar in patients undergoing salvage and primary LDLT. ADV score is surrogate biomarker for posttransplant prognosis in salvage and primary LDLT recipients. Prognostic model incorporating ADV scores can help determine whether to perform salvage LDLT.

Selection criteria of living donor liver transplantation for hepatocellular carcinoma developed in Korean transplant centers

“…However, the treatment response for post-resection tumor recurrence was not taken into account in the analysis; thus, further validation studies were necessary. Early tumor recurrence after liver resection was not a significant risk factor for posttransplant tumor recurrence in a recent high-volume study [23].…”

“…However, various treatment responses for post-resection tumor recurrence were not taken into account; thus, further validation study was necessary. A recent high-volume single-institution study demonstrated that early tumor recurrence after liver resection was not a significant risk factor for posttransplant tumor recurrence, in which a 2-factor prognostic prediction model with the Milan criteria and the ADV score at a cutoff of 4 log was proposed [23].…”

Technical refinement of inferior vena cava replacement using a synthetic vascular graft in living donor liver transplantation

“…The large-caliber synthetic vascular graft contains multiple vertical pleats which can be stretched, suggesting the need to avoid redundancy through application of adequate tension [6,7]. The indications of LDLT for HCC have been expanded beyond the Milan criteria [8][9][10][11]. A few reports revealed higher rates of posttransplant HCC recurrence following LDLT than DDLT [12,13].…”

Selection criteria of living donor liver transplantation for hepatocellular carcinoma developed in Korean transplant centers

“…The ADV score is a surrogate biomarker for posttransplant prognosis in both salvage and primary LDLT recipients. Prognostic models incorporating ADV scores can help determine whether to perform salvage LDLT [23].…”