title: When Should We Propose Liver Transplant After Resection of Hepatocellular Carcinoma? A Comparison of Salvage and De Principe Strategies.
abstract: BACKGROUND
  The aim of this study was to compare survival outcomes in patients enlisted for liver transplantation following liver resection for hepatocellular carcinoma before or at recurrence.
  
  
  METHODS
  All patients enlisted for liver transplantation following liver resection for hepatocellular carcinoma from 1996 to 2013 were included and compared according to their status at the time of enlistment: before (de principe) or at (salvage) recurrence. Primary end-point was survival since resection.
  
  
  RESULTS
  One hundred and twenty-one patients were enlisted for liver transplantation following liver resection for hepatocellular carcinoma. Ten patients enlisted for cirrhosis decompensation were excluded from the analysis. Sixty-three patients were enlisted de principe, and 48 for a salvage transplantation. Eleven patients dropped-out. According to per-protocol analysis, the mean diameter of the largest tumor was the only different pathological characteristic of initial resection between groups (31.6 mm in the de principe group versus 48.3 in the salvage, p = 0.017). The 5-year overall survival rate was significantly increased in the de principe group compared to salvage (84.6 versus 74.8%, p = 0.017). In a multivariate analysis, the salvage strategy was the only independent prognostic factor for death (p = 0.040; OR = 2.5 [1.1-5.8]).
  
  
  CONCLUSIONS
  De principe enlistment for liver transplantation following liver resection for hepatocellular carcinoma is associated with greater survival.
authors.affiliation: Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France.
authors.forename: Ecoline
authors.initials: E
authors.lastname: Tribillon
authors.affiliation: Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Barbier
authors.affiliation: Digestive, Hepato-Biliary and Pancreatic Surgery Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris VI University, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Goumard
authors.affiliation: Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.affiliation: Digestive, Hepato-Biliary and Pancreatic Surgery Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris VI University, Paris, France.
authors.forename: Fabiano
authors.initials: F
authors.lastname: Perdigao-Cotta
authors.affiliation: Hepatology Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Pathology Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.affiliation: Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Digestive, Hepato-Biliary and Pancreatic Surgery Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris VI University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.affiliation: Hepato-Biliary and Pancreatic Surgery and Liver Transplantation Department, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris VII University, Clichy, France. olivier.soubrane@bjn.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
keywords: Hepatocellular carcinoma; Liver resection; Liver transplantation