Results of salvage liver transplantation

Background & Aims Salvage liver transplantation ( SLT ) is an attractive sequential strategy which combines liver resection ( LR ) for hepatocellular carcinoma ( HCC ), followed by liver transplant ( LT ) in the event of HCC recurrence or progressive liver deterioration. To compare the long‐term results of SLT with primary liver transplant ( PLT ). Methods Between 2000 and 2011, 125 patients (72 transplantable) underwent LR and 226 underwent LT in our unit. The outcome of SLT was analysed in a two‐step fashion: firstly, SLT ( n  = 28) was compared with PLT ( n  = 198), secondly an intention‐to‐treat analysis was performed on all transplantable HCC patients who underwent LR ( LRT group = 72) compared to PLT ( n  = 198). Results The five‐year overall survival ( OS ) was 65.4% vs. 49.2% ( P  = 0.63), and disease‐free survival ( DFS ) was 89.7% vs. 80.6% ( P  = 0.31) for PLT and SLT respectively. Predictive factors for DFS after LT included HCC total diameter [hazard ratio (HR) 1.29 P  = 0.003], alpha‐foetoprotein (HR 1.002 P  < 0.001) and number of HCC nodules (HR 1.317 P  = 0.035), whereas viral hepatitis C positivity (HR 1.911 P  = 0.03) and outside Up‐to‐seven criteria (HR 2.652 P  < 0.001) were negative independent prediction factors of OS . Intention‐to‐treat analysis showed that OS at 5 years was improved in PLT vs. LRT ( LRT n  = 72 including SLT plus LR group) and was 69.4% vs. 42.2% ( P  < 0.004), with an additional increase in DFS (89.2% vs. 54.5% respectively P  < 0.001). Conclusion Salvage liver transplantation is a safe treatment strategy, as it does not impair long‐term survival. At intention‐to‐treat analysis, PLT showed improved survival compared with LRT .