Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5790-5799
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5790
Clinical analysis of patients with hepatocellular carcinoma recurrence after living-donor liver transplantation
Gun Hyung Na, Tae Ho Hong, Young Kyoung You, Dong Goo Kim
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
Country of Manuscript Source: South Korea
Author contributions: Na GH designed, performed the study, collected data, analyzed data, and wrote the paper; Hong TH and You YK designed the study; Kim DG designed, performed the study, analyzed data.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Catholic Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of the Catholic Medical Center.
Conflict-of-interest statement: The authors have no conflicts of interest or financial associations to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Goo Kim, MD, PhD, Professor, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea. kimdg@catholic.ac.kr
Telephone: +82-2-22586096 Fax: +82-2-5952822
Received: March 2, 2016
Peer-review started: March 4, 2016
First decision: April 14, 2016
Revised: April 26, 2016
Accepted: May 23, 2016
Article in press: May 23, 2016
Published online: July 7, 2016
Processing time: 124 Days and 1.9 Hours
Abstract

AIM: 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).

CONCLUSION: 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.

Keywords: Hepatocellular carcinoma, Living donor liver transplantation, mTOR inhibitor, Recurrence, Selection criteria

Core tip: Although survival rates after liver transplantation (LT) have improved dramatically, hepatocellular carcinoma (HCC) recurrence remains a significant problem and studies regarding the clinical outcomes and treatments of patients with HCC recurrence after LT are rare. In this study, satisfying the Milan criteria at living donor liver transplantation (LDLT) was important for recurrence rates after LDLT, but was not important for survival rates after HCC recurrence. Curative treatment for recurrent HCC after LDLT is the most important factor in survival rates after HCC recurrence. Combination treatments of sorafenib and an mTOR inhibitor could have survival benefits in patients with HCC recurrence after LT in the palliative treatment group.