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World J Hepatol. May 18, 2015; 7(8): 1142-1148
Published online May 18, 2015. doi: 10.4254/wjh.v7.i8.1142
Management of recurrent hepatocellular carcinoma after liver transplant
Kenneth SH Chok
Kenneth SH Chok, Department of Surgery, The University of Hong Kong, Hong Kong, China
Author contributions: Chok KSH solely contributed to this paper.
Conflict-of-interest: The author has no conflict of interest.
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: Kenneth SH Chok, MBBS, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com
Telephone: +852-2255-3025 Fax: +852-2816-5284
Received: September 5, 2014
Peer-review started: September 6, 2014
First decision: January 8, 2015
Revised: January 27, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 18, 2015
Processing time: 255 Days and 23.7 Hours
Abstract

Hepatocellular carcinoma (HCC) is the leading cause of deaths in patients with hepatitis B or C, and its incidence has increased considerably over the past decade and is still on the rise. Liver transplantation (LT) provides the best chance of cure for patients with HCC and liver cirrhosis. With the implementation of the MELD exception system for patients with HCC waitlisted for LT, the number of recipients of LT is increasing, so is the number of patients who have recurrence of HCC after LT. Treatments for intrahepatic recurrence after transplantation and after other kinds of surgery are more or less the same, but long-term cure of posttransplant recurrence is rarely seen as it is a “systemic” disease. Nonetheless, surgical resection has been shown to be effective in prolonging patient survival despite the technical difficulty in resecting graft livers. Besides surgical resection, different kinds of treatment are also in use, including transarterial chemoembolization, radiofrequency ablation, high-intensity focused ultrasound ablation, and stereotactic body radiation therapy. Targeted therapy and modulation of immunosuppressants are also adopted to treat the deadly disease.

Keywords: Hepatocellular carcinoma; Recurrence; Transarterial chemoembolization; Liver transplantation; Targeted therapy; Resection; Radiofrequency ablation; Transarterial radioembolization; Immunosuppression; Stereotactic body radiation therapy

Core tip: The management of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) seems to be a losing battle. Nonetheless, tremendous efforts have been made to combat this deadly disease. Intrahepatic recurrence may be treated by resection, which has some survival benefits as shown by small clinical trials. Other kinds of therapy including high-intensity focused ultrasound (HIFU) ablation, radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are also in use. HIFU ablation has been shown to produce better results when compared with RFA and TACE. The efficacy of systemic and targeted therapies for multiple recurrences is under investigation. Early results have suggested that the combination of sorafenib with mammalian target of rapamycin inhibitors may be useful for treating recurrent HCC after LT.