title: Late recurrence of hepatocellular carcinoma after liver transplantation.
abstract: BACKGROUND
  Long-term survival of patients with hepatocellular carcinoma (HCC) after liver transplantation is affected mainly by recurrence of HCC. There is the opinion that the chance of recurrence after 2 years post-transplantation is remote, and therefore lifelong surveillance is not justified because of limited resources. The aims of the present study were to determine the rate of late HCC recurrence (≥ 2 years after transplantation) and to compare the long-term patient survival outcomes between cases of early recurrence (<2 years after transplantation) and late recurrence.
  
  
  METHODS
  A total of 139 adult HCC patients having liver transplantation during the period from July 1994 to December 2007 were included in the analysis. The median follow-up period was 55 months. Thirty-two patients received deceased-donor grafts and 107 received living-donor grafts.
  
  
  RESULTS
  Hepatocellular carcinoma recurrence occurred in 24 (17.3%) patients, among them 22 (86%) had living-donor grafts and 7 (5%) developed late recurrence. Patients in the early recurrence group and patients in the late recurrence group had comparable demographics and disease pathology. The former group, when compared with the latter, had significantly worse overall survival at 3 years (13.3 versus 100%) and 5 years (6.67 versus 71.4%) (log-rank test; p < 0.001).
  
  
  CONCLUSIONS
  Both early recurrence and late recurrence of HCC after liver transplantation were not uncommon, mostly detected at a subclinical stage. Regular and long-term surveillance with imaging and blood tests is essential for early detection.
authors: Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, SAR, People's Republic of China. kennethchok@yahoo.com.hk
authors: Kenneth S H
authors: KS
authors: Chok
authors: See Ching
authors: SC
authors: Chan
authors: Tan To
authors: TT
authors: Cheung
authors: Albert C Y
authors: AC
authors: Chan
authors: Sheung Tat
authors: ST
authors: Fan
authors: Chung Mau
authors: CM
authors: Lo
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