Evidence-based surveillance imaging schedule after liver transplantation for hepatocellular carcinoma recurrence

Abstract

PURPOSE: here is presently no evidence-based recommendation for surveillance of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT). We aim to evaluate and develop evidence-based alternate surveillance imaging schedules for post LT HCC patients. METHOD AND MATERIALS: Imaging and pathologic reports for consecutive post-LT patients followed-up by regular surveillance imaging from a single institution's prospective database were evaluated with institutional review board approval. Outcome variable was time to diagnosis of first recurrence post-LT by surveillance imaging. Recurrence-free survival times (RFST) from alternative surveillance schedules were compared with the existing schedule (3-monthly) using a parametric frailty model. Expected delay (EpD) in diagnosis compared to the existing schedule was also computed for the alternate surveillance schedules. A p value of less than 0.05 was considered to indicate a significant difference. RESULTS: One hundred twenty five patients (108 men; 59.4 years ±16.6) underwent 1953 CT and 255 MRI scans. RFST was not significantly different in the first five years after LT when the imaging interval was extended from current 3-monthly to 6-monthly (p=0.786, EpD= 55 days). This alternative schedule incurred ten (50.0%) fewer surveillance scans than the 20 in the original schedule, and a corresponding reduction in radiation dose (if involved) and cost during the 5-year follow-up period. CONCLUSION: In conclusion, modeled alternative surveillance schedules have the potential to reduce the frequency of scans without compromising surveillance benefits. CLINICAL RELEVANCE/APPLICATION: Extending imaging surveillance schedules to 6-monthly from 3-monthly offers reduced frequency of scans without compromising surveillance benefits in post-transplant hepatocellular carcinoma patients.