title: Comparison of Salvage Living Donor Liver Transplantation and Local Regional Therapy for Recurrent Hepatocellular Carcinoma.
abstract: Salvage liver transplantation (LT) provides definite treatment for recurrent hepatocellular carcinoma (HCC) after primary liver resection. However, salvage living donor LT (SLDLT) involves more surgical difficulty, compared to local regional therapy (LRT). The optimal treatment strategy remains unclear. This study aims to compare the survival between SLDLT and LRT for patients with recurrent HCC after primary hepatic resection in a single center.
  
  
  
  Between 2001 and 2010, 211 patients with recurrent HCC after primary liver resection and a certain Milan criteria were enrolled. Among these patients, 41 and 170 patients received SLDLT and LRT, respectively. Clinical parameters were analyzed in terms of overall survival by multivariate analysis.
  
  
  
  The 1-, 3-, and 5-year overall survival rates were 90.2, 80.4, and 80.4 % in the SLDLT group, and 91.6, 71.7, and 51.1 % in LRT group, respectively. A paradoxical phenomenon of survival was noticed-a poorer survival rate within the first year in the SLDLT group but a better one after that year. For patients who survived more than 1 year, the SLDLT led to significantly better survival outcomes than LRT (P < 0.001). In multivariate analysis, SLDLT and alpha-fetoprotein (AFP) level < 200 ng/ml at recurrence were associated with better survival.
  
  
  
  To manage recurrent HCC, SLDLT with reasonable surgical mortality provided better long-term survival. AFP is an independent risk factor for overall survival.
authors.affiliation: Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung, Kao-hsiung, 833, Taiwan.
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kao-hsiung, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ming-Chao
authors.initials: MC
authors.lastname: Tsai
authors.affiliation: Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung, Kao-hsiung, 833, Taiwan. immunologylin@gmail.com.
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung, Kao-hsiung, 833, Taiwan.
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kao-hsiung, Taiwan.
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kao-hsiung, Taiwan.
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kao-hsiung, Taiwan.
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.affiliation: Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung, Kao-hsiung, 833, Taiwan.
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000628:therapy*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000628:therapy*; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins