title: Risk-based long-term screening for hepatocellular carcinoma recurrence after living donor liver transplantation.
abstract: BACKGROUND
  This study sought to establish an actual risk-based long-term screening protocol for hepatocellular carcinoma (HCC) recurrence after liver transplantation (OLT).
  
  
  METHODS
  The study was a retrospective review of medical records from 334 HCC patients who underwent primary living donor OLT and followed up for at least 5 years.
  
  
  RESULTS
  Overall 10-year patient survival rate was 67.5%, with a 4.8% perioperative mortality. HCC recurred in 68/318 (21.4%) surviving patients over a mean follow-up of 77 months. HCC recurrence was 20.7% at 5 and 22.2% at 10 years. Annual recurrence rates were 11.4%, 6.6%, and 2.0% during the first, second, and third years, respectively. Among patients within Milan criteria, the annual incidence of HCC recurrence was highest during the first 3 years; thereafter only 6 sporadic recurrences were observed during next 8 years. Among subjects beyond Milan criteria, recurrence was common during, but not after 3 years. In 43 patients (63.2%) increased alpha-fetoprotein (AFP) was an initial indication to perform further imaging studies to diagnosis recurrence, whereas they were detected incidentally on protocol screening imaging among another 25 patients (36.8%) in the absence of an AFP rise. There was a close correlation between pretransplant AFP level and AFP increase after HCC recurrence.
  
  
  CONCLUSIONS
  Patients beyond the Milan criteria require frequent tumor marker tests and imaging studies over the first 3 years; and those within Milan criteria require 10-years to follow-up primarily with tumor marker tests.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: shwang@amc.seoul.kr.
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: H C
authors.initials: HC
authors.lastname: Lee
authors.forename: Y S
authors.initials: YS
authors.lastname: Lee
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chung
authors.forename: B A
authors.initials: BA
authors.lastname: Abdulkarim
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D016031:Liver Transplantation; D019520:Living Donors; D008403:Mass Screening; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D015996:Survival Rate