title: Multidisciplinary management of recurrent hepatocellular carcinoma following liver transplantation.
abstract: BACKGROUND
  Tumor recurrence remains a main limitation to the long-term survival of patients following liver transplantation for hepatocellular carcinoma (HCC). While the majority of patients recur in the first two years after transplantation, late recurrence is not infrequent.
  
  
  CONCLUSIONS
  Most common sites of recurrence in order of decreasing frequency are liver graft, lung, bone, abdominal lymph nodes, adrenal glands and peritoneum. Reported five-year survival after surgical resection ranges from 27-88%. Few patients, however, are candidates for surgical resection. Other therapeutic options for recurrent HCC include systemic therapy, intra-arterial therapy, or radiation therapy. Although systemic molecular targeted therapy is generally tolerated with very few interactions with immunosuppressive medications, there is only modest success regarding prolongation of survival. Utilization of radiation therapy for extrahepatic recurrences similarly has minimal impact on overall survival, but may effectively in palliate symptoms. While late recurrence is associated with a more favorable prognosis than early recurrences, prognosis is still poor.
  
  
  CONCLUSIONS
  Late recurrence of HCC following transplantation should be borne in mind even after many years from transplant. Surgical salvage, when feasible, remains a viable treatment option in select patients with a chance for long-term survival. A multi-disciplinary approach is critical as different therapeutic modalities have a role in treating recurrent HCC following transplant.
authors: Department of Surgery, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Peter J
authors: PJ
authors: Kneuertz
authors: David P
authors: DP
authors: Cosgrove
authors: Andrew M
authors: AM
authors: Cameron
authors: Ihab R
authors: IR
authors: Kamel
authors: Jean-Francois H
authors: JF
authors: Geschwind
authors: Joseph M
authors: JM
authors: Herman
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*