Prognostic Factors Affecting Survival at Recurrence of Hepatocellular Carcinoma After Living-Donor Liver Transplantation: With Special Reference to Neutrophil/Lymphocyte Ratio

Background. In living-donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), it is important to predict not only who may be susceptible to recurrence but also who may survive longer. The neutrophil/lymphocyte ratio (NLR) is useful to properly assess the patient without decreasing the long-term survival after LDLT. In this study, we investigated the relationship between NLR and prognosis of patients with recurrent HCC after LDLT. Methods. In total, 167 LDLTs for HCC were enrolled in this study. Clinicopathologic factors for HCC recurrence after LDLT were investigated and prognostic factors were examined with respect to survival. Results. The following factors were found to be significant in patients with HCC recurrence compared with the controls: alpha-fetoprotein >= 300 ng/mL, des-gamma-carboxyprothrombin >= 300 mAU/mL, NLR >= 4, tumor number 93, tumor size >= 5 cm, duration of last treatment of HCC to LDLT <3 months, Milan criteria exceeded, histologic tumor number >= 10, histologic tumor size >5 cm, poor differentiation, presence of histologic vascular invasion, adjuvant chemotherapy, and interferon therapy against patients with hepatitis C virus. Male sex, interferon therapy against patients with hepatitis C virus, alpha-fetoprotein >= 300 ng/mL at recurrence, NLR >= 4 at recurrence, and nonsurgical resection for recurrent HCC were significantly related to poor prognosis. The 3-year survival rate after recurrence was 0% in patients with NLR >= 4 and 43.6% in patients with NLR <4. NLR was reelevated after LDLT in patients who later died; however, NLR gradually decreased in surviving patients. Conclusion. NLR at recurrence is a prognostic factor affecting survival after recurrence in LDLT for HCC.