title: Management of patients with recurrent hepatocellular carcinoma following living donor liver transplantation: a single center experience.
abstract: OBJECTIVE
  Tumor recurrence is the most important predictive factor for the survival of patients following liver transplantation for hepatocellular carcinoma (HCC). The management of recurrent HCC remains controversial. In this study, we presented the clinical outcomes of patients with recurrent HCC following living donor liver transplantation.
  
  
  METHODS
  Of the 109 patients who underwent liver transplantation due to hepatocellular carcinoma, sixteen (14.7%) developed tumor recurrence and were included in the study. We analyzed the management of patients with recurrent tumors and their outcomes.
  
  
  RESULTS
  The mean age of patients included in the study was 55.2 ± 7.82 (28-65) years, and 13 patients (81%) were male. The mean follow up and time to recurrence were 25.8 ± 19.2 (5-78) months and 11 ± 9.4 (4-26) months, respectively. Four patients developed recurrence in the liver graft and 12 (75%) developed recurrence in extrahepatic organs. Of these patients, seven had surgical treatment, seven received chemotherapy, and two did not receive any treatment. All four surviving patients received surgical treatment.
  
  
  CONCLUSIONS
  Recurrence of HCC following liver transplantation generally occurs in the first two years and in extrahepatic organs. The most effective treatment for patients with single and isolated recurrent tumors is surgery. However, the long term survival differed according to the type of recurrence, depending on which organs recurrence occurred in and whether recurrence was in single or multiple locations. Therefore, the treatment strategy should be individualized for longer survival.
  
  
  BACKGROUND
  The management of HCC, Recurrent HCC, Living donor liver transplantation.
authors.affiliation: Yusuf Gunay, M.D., Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey. Email: drygunay@yahoo.com Telephone: 533 597 3016.
authors.forename: Y
authors.initials: Y
authors.lastname: Gunay
authors.affiliation: Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Guler
authors.affiliation: Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Akyildiz
authors.affiliation: Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Yaprak
authors.affiliation: Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Dayangac
authors.affiliation: Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Yuzer
authors.affiliation: Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet cad Istanbul, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Tokat