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Liver Transplantation is Equally Effective as a Salvage Therapy for Patients with Hepatocellular Carcinoma Recurrence Following Radiofrequency Ablation or Liver Resection with Curative Intent

Hala Muaddi MD, MSc, David P. Al-Adra MD, PhD, Rob Beecroft MD, Anand Ghanekar MD, PhD, Carol-Anne Moulton MD, MEd, PhD, Adam Doyle MD, Markus Selzner MD, Alice Wei MDCM, MSc, Ian D. McGilvray MD, PhD, Steven Gallinger MD, MSc, David R. Grant MD, Mark S. Cattral MD, MSc, Paul D. Greig MD, John Kachura MD, Sean P. Cleary MD, MPH, MSc, Gonzalo Sapisochin MD, MSc
Hepatobiliary Tumors
Volume 25, Issue 4 / April , 2018

Abstract

Background

Liver resection (LR) and radiofrequency ablation (RFA) are curative-intent therapies for early stages of hepatocellular carcinoma (HCC). If HCC recurs, salvage liver transplant (SLT) may constitute a treatment option.

Objective

We aimed to compare the outcomes of patients transplanted for recurrent HCC after curative-intent therapies with those transplanted as initial therapy.

Methods

We conducted a matched-control (1:1) cohort study comparing patients with HCC treated with primary liver transplant (PLT) with SLT after HCC recurrence. Matching was performed according to the size and number of viable tumors at explant pathology following liver transplant.

Results

Between November 1999 and December 2014, 687 patients with HCC were listed for transplant at our institution. A total of 559 patients were transplanted; 509 patients were treated with PLT and 50 patients were treated with SLT for HCC recurrence after primary treatment with LR (n = 25) or RFA (n = 25). The median length of follow-up from transplant was 64 months (0.5–195), and the median time from curative-intent treatment of HCC with RFA or LR to recurrence was 9.5 months (1–36) and 14.5 months (3–143), respectively (p = 0.04). The matched cohort was composed of 48 SLT patients (23 LR and 25 RFA) and 48 PLT patients. The 5-year risk of recurrence after LT was 22% in the PLT group versus 32% in the SLT group (p = 0.53), while the 5-year actuarial patient survival after PLT was 69% versus 70% in the SLT group (p = 1).

Conclusion

Liver transplant is an effective treatment for patients with HCC recurrence following RFA or LR. Outcomes are similar in both groups.

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