Salvage liver transplantation for recurrent hepatocellular carcinoma after liver resection: retrospective study of the Milan and Hangzhou criteria.
BACKGROUND
Salvage liver transplantation (SLT) has recently been proposed for recurrent hepatocellular carcinoma after liver resection; however, criteria for candidate assessment in SLT have not been thoroughly evaluated.


RESULTS
We retrospectively analyzed outcomes and factors affecting survival of 53 recipients who received SLT in the Liver Transplantation Center, The First Affiliated Hospital of Zhejiang University between 2004 and 2012. Thirty recipients fulfilled the Hangzhou criteria, of which 16 also fulfilled the Milan criteria, while the remaining 23 exceeded both criteria. The 1-year, 3-year and 5-year overall survival rates and tumor-free survival rates were both superior in patients fulfilling Milan or Hangzhou criteria compared with those exceeding the criteria. For recipients outside Milan criteria but within Hangzhou criteria, the 1-year, 3-year overall survival rates were 70.1%, 70.1%, similar to recipients within Milan criteria, with the 1-year, 3-year and 5-year overall survival of 93.8%%, 62.1% and 62.1% (P = 0.586). The tumor-free survival rates were also similar between these two subgroups, with 51.9% and 51.9% vs. 85.6%, 85.6% and 64.2% during the same time interval, respectively (P = 0.054). Cox regression analysis identified Hangzhou criteria (within vs. outside, hazard ratio (HR) 0.376) and diameter of the largest tumor (HR 3.523) to be independent predictors for overall survival. The only predictor for tumor-free survival was diameter of the largest tumor (HR 22.289).


CONCLUSIONS
Hangzhou criteria safely expanded the candidate pool and are feasible in assessment of candidates for SLT. This is helpful in donor liver allocation in transplant practice.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Zhenhua
Z
Hu
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Jie
J
Zhou
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Zhiwei
Z
Li
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Jie
J
Xiang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Ze
Z
Qian
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Jian
J
Wu
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Min
M
Zhang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China ; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Zhejiang Province, Hangzhou, China ; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
Shusen
S
Zheng
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D018709:Statistics, Nonparametric; D015996:Survival Rate