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Systematic review of efficacy and outcomes of salvage liver transplantation after primary hepatic resection for hepatocellular carcinoma
Author(s) -
Chan Daniel L,
Alzahrani Nayef A,
Morris David L,
Chua Terence C
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12399
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , perioperative , cirrhosis , gastroenterology , liver disease , transplantation , surgery
Background and Aim Upfront liver transplantation is the gold standard in the treatment of patients with hepatocellular carcinoma ( HCC ) and cirrhosis, but a shortage of donor organs negatively impacts on survival outcomes, with significant disease progression during long waiting lists. This systematic review evaluates the safety and efficacy of salvage liver transplantation ( SLT ) as treatment for recurrent HCC after initial hepatic resection. Methods Electronic searches of P ubmed, E mbase, and M edline databases identified 130 abstracts, from which 16 eligible studies comprising 319 patients were selected for review. Studies adopting SLT following primary hepatic resection for recurrent HCC with more than five patients were included. Demographic details, morbidity and mortality indices, and survival outcomes were collected from each study and were tabulated. Results All patients included in the studies had liver cirrhosis, with the majority being C hild‐ P ugh A (50%) and B (33%). The etiology of liver disease was hepatitis B in the majority of patients (84%). Disease recurrence occurred in 27–80% of patients at a median of 21.4 months (range 14.5–34) following initial resection. SLT s were performed on 41% of recurrences, and were associated with biliary complications (8%), infection (11%), bleeding (8%), and vascular complications (7%). There were 18 perioperative deaths (5.6%). The median 1‐, 3‐, and 5‐year overall and disease‐free survival was 89%, 80%, and 62%, and 86%, 68%, and 67%, respectively. Conclusion Synthesis of available observational studies suggests that SLT following primary hepatic resection is a highly applicable strategy with long‐term survival outcomes that are comparable to upfront liver transplantation.