Recurrence of hepatocellular carcinoma following liver transplantation - A review of preoperative and postoperative prognostic indicators

Objective: To review the preoperative and postoperative variables that predict hepatocellular carcinoma (HCC) recurrence following orthotopic liver transplantation (OLT). Data Sources: A collective review of the literature was conducted by searching the MEDLINE database using several key words: hepatocellular carcinoma, recurrence, liver transplantation, and salvage transplantation. Study Selection: Reviews and original articles containing basic scientific observations and long-term clinical outcomes were included. Data Extraction: Critical observations from peer-reviewed sources were incorporated in this review. Data Synthesis: Overall, 11 studies were reviewed to determine the incidence of HCC recurrence following OLT studies were evaluated to determine the efficacy of salvage transplantation following liver resection. Conclusions: Liver transplantation is a viable treatment option for select patients with HCC and end-stage liver disease. However, in approximately 20% of patients, recurrent HCC is the rate-limiting factor for long-term survival. Despite identification of clinical parameters that may stratify patients at high risk and exhaustive preoperative staging, cancer recurrence is likely the result of microscopic extrahepatic disease. With a desperate donor organ shortage, locoregional ablation techniques and resection are being employed in patients on the waiting list to serve as a bridge to OLT. Furthermore, some have advocated aggressive surgical resection of isolated metastasis in both the liver and extrahepatic viscera. Whether these creative strategies confer a survival advantage is unknown; it will require long-term follow-up to determine their efficacy.