Korean J Transplant.  2022 Nov;36(Supple 1):S236. 10.4285/ATW2022.F-3764.

Outcome of total necrosis of hepatocellular carcinoma after liver transplantation: is it really totally gone?

• Kim J
• Hong SK
• Lee S
• Hong S
• Lee JM
• Choi Y
• Yi NJ
• Lee KW
• Suh KS

• KMID: 2535453
• DOI: http://doi.org/10.4285/ATW2022.F-3764

Abstract

Background
Total necrosis of hepatocellular carcinoma (HCC) by locoregional treatment (LRT) is considered to have no tumor viability. Nonetheless, there is no sufficient evidence of recurrence prevalence after liver transplantation. This study aims to investigate the prognosis of patients who are diagnosed with a totally necrotic nodule on explant hepatectomy after liver transplantation (LT).
Methods
We conducted a retrospective study of patients diagnosed with a totally necrotic nodule after liver transplantation due to HCC. A total of 165 HCC patients were included who underwent living donor or deceased donor liver transplantation from 2000 to 2020 in Seoul National University Hospital.
Results
A total of five (3.03%) patients had HCC recurrence during follow-up after transplantation. Five-year overall survival and recurrence-free survival of totally necrotic nodule patients were 92.7% and 98.1% respectively. Four (80%) patients of the recurred group showed mortality even after further treatment including TACE, surgery, or systemic treatment. Univariate anal-ysis of clinicopathological factors identified maximal diameter >5cm of a totally necrotic nodule as the only factor associated with a high probability of recurrence following LT (P=0.005).
Conclusions
Total necrosis of HCC via locoregional treatment demonstrate excellent outcome for patients undergoing transplantation. Nevertheless, preoperative large tumor size should be considered as high-risk group of recurrence after transplan-tation, suggesting active surveillance after LT.