Impact of graft type on the survival outcome of salvage Liver Transplantation for recurrent Hepatocellular Carcinoma

Abstract

Aim: To evaluate the prognostic influence of graft type on salvage liver transplantation (SLT) for recurrent hepatocellular carcinoma (HCC) Methods: A retrospective analysis of 31 patients who underwent SLT for tumor recurrence after primary surgical treatment for HCC between year 2000-2011 was conducted. All the primary tumors were within USCF criteria. Survival analysis was conducted by Kaplan-Meier methods and compared between groups by log-rank test. P-value < 0.05 was considered significant. Results: A total of 22 patients received living-related SLT (LDSLT) and the remaining 9 patients received cadaveric-related SLT (DDSLT). 10 patients (LDSLT: n=7; DDSLT: n=3) underwent hepatectomy and 21 patients (LDSLT: n=15, DDSLT: n= 6) received radiofrequency ablation as primary treatment for HCC prior to SLT. 11 patients (LDSLT:n=9 vs. DDSLT:n=2, p=0.324) underwent SLT for recurrence beyond the UCSF criteria. 5 patients in each group received TACE as bridging treatment. LDSLT patients were significantly younger (age 53 vs. 58, p=0.046)) and had higher AFP levels (187.1 vs. 30.5ng/ml, p = 0.006) at first diagnosis of HCC than DDSLT patients. There was no significant difference with regard to primary tumor size (2.5 vs. 2.5cm), time to recurrence after primary treatment (15 vs. 8 months), recurrent tumor size (4.0 vs. 4.0cm) and number (n=2 vs. 2), and serum AFP level at recurrence (27.5 vs. 5.0ng/ml) between the two groups. The 1-, 3- and 5-year recurrence-free survival rates for LDSLT were 81.8%, 61.4% and 61.4%; and the corresponding survival rates for DDSLT were all 88.9% (p = 0.176).

Conclusion Our study showed that both LDSLT and DDSLT attained satisfactory long-term survival benefit. Although statistically insignificant, DDSLT appeared to have a more favorable oncological outcome than LDSLT. Further studies with larger cohort are warranted to elucidate this issue.