Ann Hepatobiliary Pancreat Surg.  2019 Feb;23(1):1-7. 10.14701/ahbps.2019.23.1.1.

Outcomes of salvage liver transplant for recurrent hepatocellular carcinoma: A comparison with primary liver transplant

• Guo Y
• Tan EK
• Krishnamoorthy TL
• Tan CK
• Tan BH
• Tan TT
• Lee SY
• Chan CY
• Cheow PC
• Chung AY
• Jeyaraj PR
• Goh BK

• KMID: 2439039
• DOI: http://doi.org/10.14701/ahbps.2019.23.1.1

Abstract

BACKGROUNDS/AIMS
Salvage liver transplantation (SLT) is a therapeutic strategy for recurrent hepatocellular carcinoma (HCC). However, it remains controversial with compromised survival outcomes and increased perioperative morbidity compared to primary liver transplant (PLT). In the present work, we describe our institution's experience on SLT by comparing outcomes of SLT to PLT for HCCs.
METHODS
Retrospective analysis was conducted for 49 transplant patients from 2006-2017. A comparative analysis was carried out between 14 SLT patients and 35 PLT patients.
RESULTS
SLT patients demonstrated significantly shorter time to recurrence than PLT patients (median=5.5 versus 23 months, p < 0.001) with a trend towards increased perioperative major morbidity (42.9% versus 37%, p=0.711), inferior 5-year overall survival (61% versus 75%, p=0.345) and inferior 5-year recurrence-free survival (57% versus 72%, p=0.263). However, overall survival from the point of primary resection over a 10-year period showed no statistical difference between the 2 groups (SLT=60% versus PLT=61%, p=0.685).
CONCLUSIONS
SLT is a viable treatment strategy for HCCs. However, it exhibited poorer short-term perioperative and oncologic outcomes than PLT. SLT requires better patient selection with liver donor grafts for optimization of resource allocation in this era of organ shortage. Considering the worldwide shortages in liver grafts, it is hypothesized that optimization of a salvage transplant strategy may improve resource allocation and reap optimal patient outcomes.

Keyword

Hepatocellular carcinoma; Salvage liver transplantation; Primary liver transplantation; Survival

MeSH Terms

Carcinoma, Hepatocellular*
Humans
Liver Transplantation
Liver*
Patient Selection
Recurrence
Resource Allocation
Retrospective Studies
Shiga Toxin 1
Tissue Donors
Transplants
Shiga Toxin 1

Figure

• 

  Fig. 1 Comparison of survival outcomes between primary and salvage transplant. (A) Overall survival over 5 years. (B) Recurrence-free survival over 5 years. (C) Overall survival from the point of primary resection over 10 years.

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