title: Liver transplantation for hepatocellular carcinoma recurrence after liver resection: why deny this chance of cure?
abstract: BACKGROUND
  Liver transplantation (LT) after liver resection (LR) for hepatocellular carcinoma (HCC) recurrence may be associated with poor patient long-term results and higher perioperative patient morbidity and mortality. This study focused on short-term and long-term outcomes of LT recipients due to HCC recurrence after LR in a single-institution cohort, and in highly comparable case-matched subgroups.
  
  
  METHODS
  Between 2000 and 2009, 570 consecutive patients with documented HCC underwent LR (n=355, 62.2%) or LT (n=215, 37.8%) at our Institute. The case-matched analysis was between 2 groups: group A1, LT recipients who had already undergone LR (n=26); group B1, LT recipients who had not already undergone LR (n=26).
  
  
  RESULTS
  Patient morbidity was higher in the A1 group in terms of packed red blood cell units transfused, fresh frozen plasma units transfused, median operative time, postoperative bleeding, and postoperative reoperations. No differences were detected in terms of patient mortality, patient survival, and patient recurrence-free survival at the univariate and multivariate analysis.
  
  
  CONCLUSIONS
  Although LT among patients who have already undergone LR is associated with higher risk of patient morbidity, patient long-term survival and recurrence-free survival is not impaired. Therefore, there do not seem to be any valid reasons to deny the chance of LT to patients who have already undergone LR.
authors.affiliation: Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Iacopo
authors.initials: I
authors.lastname: Mangoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Lauterio
authors.forename: Plamen
authors.initials: P
authors.lastname: Mihaylov
authors.forename: Caterina
authors.initials: C
authors.lastname: Cusumano
authors.forename: Antonio
authors.initials: A
authors.lastname: Rampoldi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome