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Abstract Details
Early Versus Late Hepatocellular Carcinoma Recurrence After Transplantation: Predictive Factors, Patterns, and Long-term Outcome
Transplantation. 2021 Aug 1;105(8):1778-1790.doi: 10.1097/TP.0000000000003434.
Nada El-Domiaty12, Faouzi Saliba1, Eric Vibert1, Vincent Karam1, Rodolphe Sobesky1, Wafaa Ibrahim3, Gabriella Pittau1, Oriana Ciacio1, Chady Salloum1, Khaled Amer4, Maysaa A Saeed2, Jihan A Shawky2, Antonio Sa Cunha1, Olivier Rosmorduc1, Daniel Cherqui1, René Adam1, Didier Samuel1
Author information
1AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France.
2Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
3Statistics Department, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt.
4Hepato-Biliary and Liver Transplant Department, International Medical Center, Cairo, Egypt.
Abstract
Background: Hepatocellular carcinoma (HCC) is currently the first indication of liver transplantation (LT) in Europe and Asia-Pacific region and the third in the United States. HCC recurrence is the main complication affecting short- and medium-term outcomes after LT.
Methods: A total of 433 consecutive adult recipients transplanted for HCC between 2000 and 2017 (mean age: 57.8 ± 8.5 y; 83.8% were males) with a mean follow-up of 74.6 ± 58.6 months were included. Patients had to meet Milan criteria and, since 2014, alpha-fetoprotein score to be listed. Patients with HCC recurrence were classified into early (≤2 y) and late recurrence (>2 y) and were retrospectively reviewed.
Results: Patients who developed recurrence (75 patients, 17%) had more tumors outside Milan and University of California San Francisco criteria, high alpha-fetoprotein score, and microvascular invasion at pathology. Early recurrence developed in 46 patients (61.3%); the overall 5- and 10-year survival rates of these patients from time of LT were 6.7% and 0%, which were significantly lower than those with late recurrence 64.0% and 27.1%, respectively (P < 0.001). The median survival times from the diagnosis of HCC recurrence were 15 and 17 months, respectively, in the 2 groups (P < 0.001). Multivariable Cox regression analysis identified alcoholic cirrhosis as etiology of the underlying liver disease (hazard ratio [HR] = 3.074; P = 0.007), bilobar tumor at time of LT (HR = 2.001; P = 0.037), and a tumor size (>50 mm) in the explant (HR = 1.277; P = 0.045) as independent predictors of early recurrence.
Conclusions: Improving the prediction of early HCC recurrence could optimize patient selection for LT, potential adjuvant therapy with new targeted drugs and hence, improve long-term survival.