Primary versus salvage liver transplantation for hepatocellular carcinoma within Milan criteria: a single center experience

Abstract

BACKGROUND: Under the pressure of the shortage of deceased liver graft, the application of primary liver transplant (PLT) for hepatocellular carcinoma (HCC) within Milan criteria is limited. The approach of primary hepatic resection and salvage liver transplant (SLT) for intrahepatic recurrence is then increasingly adopted. However, the comparison of survival outcome between PLT and SLT for HCC is controversial in the literature. AIM OF STUDY: To compare the long-term survival outcome between PLT and SLT for HCC within Milan criteria PATIENTS AND METHODS: From July 1995 to December 2007, a total of 75 patients who underwent liver transplant for HCC within Milan criteria were retrospectively analyzed. There were 67 patients receiving PLT (Group 1) and 8 patients receiving SLT after primary hepatic resection for recurrence (Group 2). Clinicopathologic characteristics, perioperative outcome and long-term survival were compared between the two groups. RESULTS: Patients in group 2 had better liver function in terms of lower Child-Pugh score and MELD score than those in group 1.There was higher proportion of patients receiving living donor liver transplant in group 2 (7 of 8 patients; 87.5%) than group 1 (50 of 67 patients; 74.6%). Waiting time was shorter and graft weight to standard liver weight ratio was lower in group 2 than group 1. Other clinicopathologic characteristics were comparable between the two groups. There were no significant differences between group 1 and 2 in morbidity rate (81 % vs. 75%) and mortality (15% vs. 13%). With median follow-up period of 36 months (range 4 – 120 months), the overall recurrence-free survival was significantly worse in group 2 than group 1 (1-year: 87.5% vs. 92.5%; 3-year: 72.9% vs. 86.1%; 5-year: 36.4% vs. 81.5%). CONCLUSION: Despite strict selection criteria based on tumor size and number, patients who underwent SLT had significantly worse recurrence-free survival than those receiving PLT for HCC.