Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy

Table 1 Demographic and clinical data

Factors	Rescue OLT group (n = 15)	De novo OLT group (n = 62)
Age (yr)1	50.0 (46.0-55.0)	49.0 (44.0-55.0)
Male, No. (%)	14 (93.3)	51 (82.3)
Excessive alcohol use, No. (%)	5 (33.3)	13 (21.0)
Tobacco use, No. (%)	7 (46.7)	52 (83.9)
Family history of liver cancer, No. (%)	3 (20.0)	8 (12.9)
Hepatitis B infection, No. (%)	15 (100.0)	57 (91.9)
Diabetes, No. (%)	2 (13.3)	7 (11.3)
Liver cirrhosis, No. (%)	15 (100.0)	60 (96.8)
Months from tumor detection to OLT1	1.0 (1.0, 3.0)	2.0 (1.0, 3.0)
Child-Pugh Score, No. (%)
A	7 (46.7)	39 (62.9)
B	6 (40.0)	23 (37.1)
C	2 (13.3)	0 (0.0)
UICC pTNM tumor staging1	3.0 (3.0, 3.0)	3.0 (3.0, 3.0)
Total bilirubin (&mgr;mol/L)1	22.8 (15.0, 54.6)	32.1 (23.0, 55.4)
Direct bilirubin (&mgr;mol/L)1	10.4 (5.8, 35.3)	14.4 (9.8, 29.5)
Albumin (g/L)1	35.3 (32.1, 42.1)	34.5 (32.0, 37.6)
Prealbumin (g/L)1	12.7 (9.3, 15.3)	10.3 (6.9, 14.5)
Alanine aminotransferase (U/L)1	90.1 (37.7, 183.9)	48.9 (37.8, 91.7)
Asparate aminotransferase (U/L)1	85.4 (36.5, 150.0)	65.5 (47.1, 99.4)
Prothrombin time (s)1	14.5 (13.3, 17.9)	15.2 (13.4, 17.8)
Activated partial thromboplastin time (s)1	34.7 (31.8, 38.0)	34.8 (30.7, 41.3)
OLT operating room time (h)1	8.0 (7.2, 8.1)	6.8 (5.7, 7.7)
OLT anhepatic time (min)1	65.0 (60.0, 81.0)	62.0 (56.0, 74.0)
OLT intra-op bleeding (L)1	2.0 (1.5, 2.3)	1.5 (1.2, 2.0)
OLT intra-op transfusion (L)1	1.6 (1.0, 2.0)	0.8 (0.4, 1.4)
OLT post-op transfusion (L)1	1.2 (0.8, 2.0)	0.4 (0.0, 1.4)
Pre-OLT α-fetoprotein (U/L)1	7.5 (4.9, 27.1)	362.6 (20.4, 3480.0)
Post-OLT α-fetoprotein (U/L)1	5.3 (4.1, 10.9)	15.7 (5.4, 120.4)
Change in α-fetoprotein after OLT1	4.2 (0.8, 21.8)	337.9 (13.3, 3023.5)
Postoperative histopathology1
Size of largest tumor in diameter (cm)1	3.0 (1.5, 6.0)	3.6 (2.5, 6.0)
Number of tumor1	1.0 (1.0, 4.0)	1.0 (1.0, 2.0)
Histology differentiation of tumor, No. (%)
Moderate	8 (53.3)	9 (14.5)
Poor	7 (46.7)	53 (85.5)
Tumor vascular invasion, No. (%)
None	5 (33.3)	26 (41.9)
Microvascular	8 (53.3)	33 (53.2)
Macrovascular	2 (13.3)	3 (4.8)
Tumor in right lobe, No. (%)	13 (86.7)	53 (85.5)
Post-OLT treatment, No. (%)
None	1 (6.7)	2 (3.2)
Chemotherapy	14 (93.3)	60 (96.8)
Time of follow-up (mo)1	18.0 (12.0, 24.0)	21.0 (14.0, 32.0)

¹Statistics presented are medians (Q25, Q75).

Table 2 Initial clinical data of HCC at time of tumor resection in the study group (n = 15)

Factors	n
Years since tumor detection1	4.0 (3.0, 5.0)
Mean diameter of tumor (cm)1	4.5 (3.0, 8.0)
Tumor-free interval after resection (mo)1	26.0 (6.0, 38.0)
Microsatellite lesions (%)
0	11 (73.3)
1	4 (26.7)
Number of post-resection trans-catheter
Arterial chemoembolization
0	3 (20)
1	4 (26.7)
2	5 (33.3)
3	2 (13.3)
6	1 (6.7)
Number of post-resection percutaneous ethanol injection
0	13 (86.7)
3	1 (6.7)
16	1 (6.7)
Tumor in the left lobe (%)	12 (80)
Unifocal tumor (%)	15 (100)
Vascular invasion (%)
None	10 (66.7)
Microvascular	3 (20)
Macrovascular	2 (13.3)
Non-encapsulated tumor (%)	9 (60)

¹Statistics presented are median (Q25, Q75).

Table 3 Univariable Cox proportional hazards models

	Factor	Hazard ratio (95% CI)	P
Demographic	Age	0.92 (0.88-0.97)	< 0.001
	Gender (male vs female)	1.6 (0.36-6.9)	0.54
	Tobacco (yes vs no)	1.7 (0.48-5.8)	0.42
	Excess alcohol use (no vs yes)	1.1 (0.37-3.4)	0.83
	Family history liver cancer (yes vs no)	4.4 (1.6-11.9)	0.004
	Diabetes (yes vs no)	1.4 (0.42-5.0)	0.57
	Interval from tumor detection to OLT in mo	0.99 (0.91-1.07)	0.74
Disease groups	Recurrent liver cancer (yes vs no)	1.02 (0.29-3.5)	0.98
Preoperative laboratory tests	Total bilirubin	1.01 (1.004-1.01)	< 0.001
	Direct bilirubin	1.01 (1.01-1.01)	< 0.001
	Albumin	0.99 (0.90-1.10)	0.91
	Pre-albumin	0.91 (0.82-1.02)	0.11
	Alanine aminotransferase	1.00 (1.00-1.01)	0.57
	Asparate aminotransferase	1.00 (1.00-1.01)	0.15
	Prothrombin time	1.04 (0.92-1.2)	0.51
	Activated partial thromboplastin time	1.01 (0.96-1.08)	0.62
Tumor histopathology	Size of largest tumor (cm)	1.1 (1.03-1.2)	0.009
	Tumor staging	1.6 (0.43-6.2)	0.47
	Tumor range	1.3 (0.90-1.9)	0.16
	Tumor location (left vs right)	1.2 (0.33-4.0)	0.82
	Microembolism (micro vs none)	2.1 (0.67-6.7)	0.2
	Microembolism (macro vs none)	10.5 (2.3-48.3)	0.003
Preoperative staging	Child-Pugh Score	1.5 (0.67-3.4)	0.31
Intraoperative factors	OLT operative room time (h)	1.1 (0.80-1.6)	0.48
	OLT anhepatic time (min)	0.97 (0.92-1.01)	0.11
	OLT intra-op bleeding (L)	0.47 (0.20-1.1)	0.097
	OLT intra-op transfusion (L)	0.73 (0.43-1.2)	0.24
	OLT post-op transfusion (L)	1.1 (0.90-1.4)	0.33

Table 4 Multivariable Cox proportional hazards model

Factors	Hazard ratio (95% CI)	P
Recurrent liver cancer (yes vs no)	1.7 (0.38-7.2)	0.5
Total bilirubin	1.01 (1.006-1.02)	< 0.0001
OLT post-op transfusion (L)	1.4 (1.1-1.8)	0.008
Size of largest tumor (cm)	1.3 (1.1-1.4)	0.0004
Family history liver cancer (yes vs no)	7.7 (2.2-26.9)	0.001
Microembolism (yes vs no)	3.4 (0.85-13.5)	0.08