title: Clinical analysis of patients with hepatocellular carcinoma recurrence after living-donor liver transplantation.
abstract: OBJECTIVE
  To evaluated patterns and outcomes of hepatocellular carcinoma (HCC) recurrence after living donor liver transplantation (LDLT).
  
  
  METHODS
  From 2001 to 2014, 293 patients underwent LDLT for HCC at our transplant center. We retrospectively reviewed 54 (18.4%) patients with HCC recurrence after LDLT. We evaluated patterns and outcomes of HCC recurrence after LDLT, with particular attention to the Milan criteria at transplantation, treatments for HCC-recurrent patients, and factors related to survival after HCC recurrence. Furthermore, we evaluated the efficacy of combination treatment of sorafenib and an mTOR inhibitor.
  
  
  RESULTS
  The 1-, 2-, and 3-year overall survival rates after HCC recurrence were 41.1%, 20.5%, and 15.4%, respectively. The median time interval between LDLT and HCC recurrence was 6.5 mo. Although recurrence rates according to the Milan criteria at LDLT were significantly different, HCC recurrence patterns and survival rates after HCC recurrence were not significantly different between the two groups. Time to recurrence < 12 mo (P = 0.048), multiple recurrences at HCC recurrence (P = 0.038), and palliative treatment for recurrent tumors (P = 0.003) were significant independent prognostic factors for poor survival after HCC recurrence in a multivariate analysis. The combination treatment of sorafenib and sirolimus showed survival benefits in the palliative treatment group (P = 0.005).
  
  
  CONCLUSIONS
  Curative treatment for recurrent HCC after LDLT is the most important factor in survival rates after HCC recurrence and combination treatments of sorafenib and an mTOR inhibitor could have survival benefits in patients with HCC recurrence after LT in the palliative treatment group.
authors.affiliation: Gun Hyung Na, Tae Ho Hong, Young Kyoung You, Dong Goo Kim, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Gun Hyung
authors.initials: GH
authors.lastname: Na
authors.affiliation: Gun Hyung Na, Tae Ho Hong, Young Kyoung You, Dong Goo Kim, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Hong
authors.affiliation: Gun Hyung Na, Tae Ho Hong, Young Kyoung You, Dong Goo Kim, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: You
authors.affiliation: Gun Hyung Na, Tae Ho Hong, Young Kyoung You, Dong Goo Kim, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Dong Goo
authors.initials: DG
authors.lastname: Kim
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000453:epidemiology; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D020123:Sirolimus
keywords: Hepatocellular carcinoma; Living donor liver transplantation; Recurrence; Selection criteria; mTOR inhibitor