Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2018; 24(45): 5081-5094
Published online Dec 7, 2018. doi: 10.3748/wjg.v24.i45.5081
Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm
Kin Pan Au, Kenneth Siu Ho Chok
Kin Pan Au, Department of Surgery, Queen Mary Hospital, Hong Kong, China
Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Chok KSH proposed the study; Au KP and Chok KSH conducted the literature review and wrote up the manuscript.
Correspondence author to: Kenneth Siu Ho Chok, FRCS (Ed), Associate Professor, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Telephone: +86-852-22553025 Fax: +86-852-28165284
Received: September 1, 2018
Peer-review started: September 1, 2018
First decision: October 14, 2018
Revised: October 21, 2018
Accepted: November 7, 2018
Article in press: November 7, 2018
Published online: December 7, 2018
Core Tip

Core tip: We propose a multi-disciplinary management algorithm for recurrent hepatocellular carcinoma after liver transplantation. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor can be considered. Staging is performed to differentiate between disseminated recurrence and oligo-recurrence. In patients with disseminated recurrence, sorafenib may confer survival benefits but is associated with significant toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic and extra-hepatic oligo-recurrences can be managed with surgical resection, ablative therapy or regional treatments depending on the disease status.