J Korean Med Sci.  2014 Oct;29(10):1360-1366. 10.3346/jkms.2014.29.10.1360.

Optimal Tailored Screening Protocol after Living Donor Liver Transplantation for Hepatocellular Carcinoma

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. kwleegs@gmail.com
  • 2Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

The indication for hepatocellular carcinoma (HCC) is expanding in living donor liver transplantation (LDLT). Early detection and effective management of recurrence has become an important issue in LDLT for HCC. This study aimed to find an optimal screening protocol in terms of screening interval and screening tools by analyzing recurrence pattern after LDLT for HCC. A total of 205 LDLT patients in two centers from February 1999 to October 2010 was reviewed. Recurrence appeared in 55 cases. Six risk factors for recurrence were identified: preoperative alpha-fetoprotein >400, Edmonson grade 3 or 4, tumor size >7 cm, tumor number > or =7, minimal tumor necrosis in the transarterial chemoembolization group and positive micro-vascular invasion. Four groups with different ranges of index scores showed different recurrence-free survival and median time to recurrence. Group I showed low and late recurrence. Groups II and III showed linearly increased rate of recurrence until 18 months. Group IV showed very early recurrence within 6 months. Across the groups, extra-hepatic recurrence developed in more than 40% of cases and multi-organ recurrence rate was 20%. The screening interval should be different based on the risk of recurrence. Screening should include work-up for extra-hepatic recurrence as well as intra-hepatic recurrence.

Keyword

Carcinoma; Hepatocellular; Living Donors; Liver Transplantation; Recurrence; Screening

MeSH Terms

Carcinoma, Hepatocellular/pathology/*surgery
Chemoembolization, Therapeutic/adverse effects
Disease-Free Survival
Female
Humans
Liver Neoplasms/pathology/*surgery
*Liver Transplantation
Living Donors
Male
Middle Aged
Neoplasm Recurrence, Local/*pathology
Risk Factors
Treatment Outcome

Figure

  • Fig. 1 Recurrence free survival rate of 205 patients with hepatocellular carcinoma who underwent living donor liver transplantation.

  • Fig. 2 Cumulative recurrence rates according to group based on the risk index. Group I shows very low and late recurrence after 18 months. In groups II and III, most recurrences develop within the first 18 months in a temporally linear manner. Group IV shows an early recurrence pattern within 6 months in most cases.

  • Fig. 3 Recurrence free survival rates according to UCSF criteria. (A) Recurrence free survival rates of patients who met UCSF criteria according to group. (B) Recurrence free survival rates of patients who were outside of UCSF criteria according to group.

  • Fig. 4 Surgical treatment significantly improves the overall survival after tumor recurrence.


Cited by  2 articles

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Seong Hee Kang, Hyeki Cho, Eun Ju Cho, Jeong-Hoon Lee, Su Jong Yu, Yoon Jun Kim, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh, Jung-Hwan Yoon
J Korean Med Sci. 2018;33(45):.    doi: 10.3346/jkms.2018.33.e283.

Management of very late peritoneal metastasis of hepatocellular carcinoma 10 years after liver transplantation: Lessons from two cases
Abdulwahab A Alshahrani, Shin Hwang, Gi-Won Song, Deok-Bog Moon, Dong-Hwan Jung, Chul-Soo Ahn, Ki-Hun Kim, Tae-Yong Ha, Gil-Chun Park, Su-Min Ha, Yo-Han Park, Sung-Gyu Lee
Ann Hepatobiliary Pancreat Surg. 2018;22(2):136-143.    doi: 10.14701/ahbps.2018.22.2.136.


Reference

1. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996; 334:693–699.
2. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001; 33:1394–1403.
3. Park MS, Lee KW, Suh SW, You T, Choi Y, Kim H, Hong G, Yi NJ, Kwon CH, Joh JW, et al. Living-donor liver transplantation associated with higher incidence of hepatocellular carcinoma recurrence than deceased-donor liver transplantation. Transplantation. 2014; 97:71–77.
4. Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi GE, Krieger NR, Schwartz ME. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl. 2004; 10:534–540.
5. Shin WY, Suh KS, Lee HW, Kim J, Kim T, Yi NJ, Lee KU. Prognostic factors affecting survival after recurrence in adult living donor liver transplantation for hepatocellular carcinoma. Liver Transpl. 2010; 16:678–684.
6. Yang SH, Suh KS, Lee HW, Cho EH, Cho JY, Cho YB, Kim IH, Yi NJ, Lee KU. A revised scoring system utilizing serum alphafetoprotein levels to expand candidates for living donor transplantation in hepatocellular carcinoma. Surgery. 2007; 141:598–609.
7. Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, Aishima S, Terashi T, Shimada M, Maehara Y. Extended indication for living donor liver transplantation in patients with hepatocellular carcinoma. Transplantation. 2007; 83:893–899.
8. Lee SG, Hwang S, Moon DB, Ahn CS, Kim KH, Sung KB, Ko GY, Park KM, Ha TY, Song GW. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl. 2008; 14:935–945.
9. Zheng SS, Xu X, Wu J, Chen J, Wang WL, Zhang M, Liang TB, Wu LM. Liver transplantation for hepatocellular carcinoma: Hangzhou experiences. Transplantation. 2008; 85:1726–1732.
10. Cillo U, Navaglia F, Vitale A, Molari A, Basso D, Bassanello M, Brolese A, Zanus G, Montin U, D'Amico F, et al. Clinical significance of alpha-fetoprotein mRNA in blood of patients with hepatocellular carcinoma. Clin Chim Acta. 2004; 347:129–138.
11. Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, Camerini T, Roayaie S, Schwartz ME, Grazi GL, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009; 10:35–43.
12. Graziadei IW, Sandmueller H, Waldenberger P, Koenigsrainer A, Nachbaur K, Jaschke W, Margreiter R, Vogel W. Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl. 2003; 9:557–563.
13. Roayaie S, Frischer JS, Emre SH, Fishbein TM, Sheiner PA, Sung M, Miller CM, Schwartz ME. Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters. Ann Surg. 2002; 235:533–539.
14. Majno PE, Adam R, Bismuth H, Castaing D, Ariche A, Krissat J, Perrin H, Azoulay D. Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis. Ann Surg. 1997; 226:688–701. discussion-3.
15. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg. 2002; 235:373–382.
16. Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Tahara M, Suzuki T, Shimamura T, Furukawa H, Matsushita M, Todo S. Recurrence patterns after hepatectomy of hepatocellular carcinoma: implication of Milan criteria utilization. Ann Surg Oncol. 2009; 16:1560–1571.
17. Lee KK, Kim DG, Moon IS, Lee MD, Park JH. Liver transplantation versus liver resection for the treatment of hepatocellular carcinoma. J Surg Oncol. 2010; 101:47–53.
18. Kim YK, Lee KW, Cho SY, Han SS, Kim SH, Kim SK, Park SJ. Usefulness 18F-FDG positron emission tomography/computed tomography for detecting recurrence of hepatocellular carcinoma in posttransplant patients. Liver Transpl. 2010; 16:767–772.
19. Schlitt HJ, Neipp M, Weimann A, Oldhafer KJ, Schmoll E, Boeker K, Nashan B, Kubicka S, Maschek H, Tusch G, et al. Recurrence patterns of hepatocellular and fibrolamellar carcinoma after liver transplantation. J Clin Oncol. 1999; 17:324–331.
20. Ladabaum U, Cheng SL, Yao FY, Roberts JP. Cost-effectiveness of screening for recurrent hepatocellular carcinoma after liver transplantation. Clin Transplant. 2011; 25:283–291.
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