Factors predicting survival after post-transplant hepatocellular carcinoma recurrence.
BACKGROUND
Although factors associated with an increased risk of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been extensively studied, the history of patients with a post-transplant recurrence is poorly known.


METHODS
Patients experiencing a post-transplant HCC recurrence from 1996 to 2011 in two transplant programs were included. Demographic, transplant, and post-recurrence variables were assessed.


RESULTS
Thirty patients experienced an HCC recurrence-22 men and 8 women with a mean age of 55 ± 6 years. Sixteen (53 %) were outside the Milan criteria at the time of transplantation. Most recurrences (60 %) appeared within the first 18 months after transplantation, ranging between 1.7 and 109 months (median 14.2 months). Mean post-recurrence survival was 33 ± 31 months. On univariate analysis, total tumor volume (TTV; p = 0.047), microvascular invasion (p = 0.011), and time from transplant to recurrence (p = 0.001) predicted post-recurrence survival. On multivariate analysis, both time from transplant to recurrence (p = 0.001) and history of rejection (p = 0.043), but not the location of the recurrence or the type of recurrence treatment, predicted post-recurrence survival.


CONCLUSIONS
This study suggests that patients with early post-transplant HCC recurrence have worse outcomes. Those with a history of graft rejection have better survivals, possibly due to more active anti-cancer immunity.
Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. christian.toso@hcuge.ch
Christian
C
Toso
Sonia
S
Cader
Ariane
A
Mentha-Dugerdil
Glenda
G
Meeberg
Pietro
P
Majno
Isabelle
I
Morard
Emiliano
E
Giostra
Thierry
T
Berney
Philippe
P
Morel
Gilles
G
Mentha
Norman M
NM
Kneteman
D000416:Alberta / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome