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Different prognostic factors and strategies for early and late recurrence after adult living donor liver transplantation for hepatocellular carcinoma
Author(s) -
Hong Suk Kyun,
Lee KwangWoong,
Yoon Kyung Chul,
Kim HyoSin,
Ahn SungWoo,
Kim Hyeyoung,
Lee JeongMoo,
Cho JaeHyung,
Yi NamJoon,
Suh KyungSuk
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13703
Subject(s) - medicine , hepatocellular carcinoma , multivariate analysis , liver transplantation , surgery , gastroenterology , transplantation , milan criteria , oncology
Background Some patients with hepatocellular carcinoma (HCC) recurrence after LT show good long‐term survival. We aimed to determine the prognostic factors affecting survival after recurrence and to suggest treatment strategies. Methods Between January 2000 and December 2015, 532 patients underwent adult living donor liver transplantation (LDLT) for HCC. Among these, 92 (17.3%) who experienced recurrence were retrospectively reviewed. Results The 1‐, 3‐, and 5‐year survival rates after recurrence were 59.5%, 23.0%, and 11.9%, respectively. In multivariate analysis, time to recurrence >6 months and surgical resection after recurrence were related to longer survival after recurrence, while multi‐organ involvement at the time of primary recurrence was related to poorer survival. We classified patients into early (≤6 months) and late (>6 months) recurrence groups. In the early recurrence group, tumor size >5 cm in the explant liver, liver as the first detected site of recurrence, and multiple organ involvement at primary recurrence were related to survival on multivariate analysis. In the late recurrence group, mammalian target of rapamycin inhibitor (mTORi) usage and multi‐organ involvement were significantly associated with the prognosis on multivariate analysis. Conclusions Various therapeutic approaches are needed depending on the period of recurrence after LT and multiplicity of involved organs.