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Impact of Time to Recurrence on Survival Outcome of Salvage Liver Transplantation

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Salvage liver transplantation (SLT) is the ideal treatment for patients with recurrent hepatocellular carcinoma (HCC) and liver cirrhosis. The optimal timing for offering SLT was controversial. This study aimed at investigating the impact of time to recurrence and other prognostic factors on survival outcome after SLT.

Methods

Between May 2000 and April 2019, patients who had undergone hepatectomy or ablation for HCC and later received SLT in Queen Mary Hospital were included. Clinico-pathological data during primary treatment and SLT were retrospectively reviewed. Kaplan–Meier analysis and log-rank test were used to determine overall and disease-free survival after SLT. Prognostic factors affecting overall and disease-free survival were determined by multivariate analysis using Cox regression analysis. P-value of less than 0.05 was considered statistically significant.

Results

Fifty-three patients were identified within the specified period including 22 patients in early recurrence group (ER group, time to recurrence within 1 year) and 31 patients in late recurrence group (LR group, time to recurrence more than 1 year). The 1-, 5-, and 10-year overall survival after primary treatment was 100%, 76.6%, and 61.1% in the ER group and 100%, 90%, and 76.4% in the LR group (p = 0.59). There were no statistical differences in overall survival (p = 0.84) and disease-free survival (p = 0.85) after SLT between ER and LR group. Pre-transplant alpha-fetoprotein >  = 400 ng/mL (p = 0.007) and macrovascular invasion in explant (p = 0.002) were independent risk factors for shorter overall survival after primary treatment.

Conclusion

Time to recurrence after primary treatment of HCC did not affect survival outcome after SLT. With careful patient selection, SLT could be offered to patient with early or late tumor recurrence.

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Abbreviations

AFP:

Alpha-fetoprotein

CI:

Confidence interval

CT:

Computed tomography

DDLT:

Deceased donor liver transplantation

HR:

Hazard ratio

HCC:

Hepatocellular carcinoma

HIFU:

High-intensity focused ultrasound

INR:

International normalized ratio

ICG:

Indocyanine green

LDLT:

Living donor liver transplantation

MELD:

Model for end-stage liver disease

MRI:

Magnetic resonance imaging

MWA:

Microwave ablation

RFA:

Radiofrequency ablation

SBRT:

Stereotactic body radiotherapy

SLT:

Salvage liver transplantation

TACE:

Trans-arterial chemoembolization

UCSF:

University of California, San Francisco

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Correspondence to Wong Hoi She.

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Wong, P.C., She, W.H., Ma, K.W. et al. Impact of Time to Recurrence on Survival Outcome of Salvage Liver Transplantation. J Gastrointest Surg 26, 813–821 (2022). https://doi.org/10.1007/s11605-021-05146-3

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  • DOI: https://doi.org/10.1007/s11605-021-05146-3

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