Early Versus Late Hepatocellular Carcinoma Recurrence After Transplantation: Predictive Factors, Patterns, and Long-term Outcome

Background. Hepatocellular carcinoma (HCC) is currently the first indication of liver transplantation (LT) in Europe and Asia-Pacific region and the third in the United States. HCC recurrence is the main complication affecting short- and medium-term outcomes after LT. Methods. A total of 433 consecutive adult recipients transplanted for HCC between 2000 and 2017 (mean age: 57.8 +/- 8.5 y; 83.8% were males) with a mean follow-up of 74.6 +/- 58.6 months were included. Patients had to meet Milan criteria and, since 2014, alpha-fetoprotein score to be listed. Patients with HCC recurrence were classified into early (<= 2 y) and late recurrence (>2 y) and were retrospectively reviewed. Results. Patients who developed recurrence (75 patients, 17%) had more tumors outside Milan and University of California San Francisco criteria, high alpha-fetoprotein score, and microvascular invasion at pathology. Early recurrence developed in 46 patients (61.3%); the overall 5- and 10-year survival rates of these patients from time of LT were 6.7% and 0%, which were significantly lower than those with late recurrence 64.0% and 27.1%, respectively (P < 0.001). The median survival times from the diagnosis of HCC recurrence were 15 and 17 months, respectively, in the 2 groups (P < 0.001). Multivariable Cox regression analysis identified alcoholic cirrhosis as etiology of the underlying liver disease (hazard ratio [HR] = 3.074; P = 0.007), bilobar tumor at time of LT (HR = 2.001; P = 0.037), and a tumor size (>50 mm) in the explant (HR = 1.277; P = 0.045) as independent predictors of early recurrence. Conclusions. Improving the prediction of early HCC recurrence could optimize patient selection for LT, potential adjuvant therapy with new targeted drugs and hence, improve long-term survival.

Automated summary

The study found that recurrence of hepatocellular carcinoma (HCC) has a significant impact on short- and medium-term outcomes after liver transplantation, with significantly lower survival rates among patients with early recurrence compared to those with late recurrence. Factors such as alcoholic cirrhosis, bilobar tumor at the time of LT, and tumor size in the explant have been identified as independent predictors of early recurrence.