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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatocellular carcinoma recurrence after liver transplant: An Australian single-centre study
Matthew G Garas, Luis Calzadilla-Bertot, Briohny W Smith, Luc Delriviere, Byron Jaques, Lingjun Mou, Leon A Adams, Gerry C MacQuillan, George Garas, Gary P Jeffrey, Michael C Wallace
Matthew G Garas, Luis Calzadilla-Bertot, Leon A Adams, Gerry C MacQuillan, George Garas, Gary P Jeffrey, Michael C Wallace, Medical School, University of Western Australia, Nedlands 6009, Western Australia, Australia
Luis Calzadilla-Bertot, Briohny W Smith, Leon A Adams, Gerry C MacQuillan, George Garas, Gary P Jeffrey, Michael C Wallace, Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands 6009, Western Australia, Australia
Luc Delriviere, Byron Jaques, Lingjun Mou, Department of Surgery, Sir Charles Gairdner Hospital, Nedlands 6009, Western Australia, Australia
Author contributions: Garas MG conceptualised and designed the study, coordinated and completed the data collection, carried out the data analysis, drafted the initial manuscript, and critically reviewed and revised the manuscript; Calzadilla-Bertot L conceptualised and designed the study, carried out a formal data analysis, critically reviewed and revised the manuscript; Smith BW, Delriviere L, Jaques B, Mou L, Adams LA, MacQuillan GC, Garas G, and Jeffrey GP conceptualised and designed the study and critically reviewed and revised the manuscript; Wallace MC conceptualised and designed the study, supervised the data collection and analysis, critically reviewed and revised the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was reviewed and approved by the Sir Charles Gairdner Osborne Park Health Care Group Human Research Ethics Committee, No. 47721.
Informed consent statement: Participants were not required to provide informed consent for this study. The data was de-identified and collected retrospectively for this cohort study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The de-identified data is not publicly available, but requests to the corresponding author for the data will be considered on a case-by-case basis.
STROBE statement: The authors have read the STROBE statement–checklist of items, and the manuscript was prepared and revised according to the STROBE statement–checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Matthew Garas, BSc, Researcher, Medical School, University of Western Australia, 35 Stirling Highway, Nedlands 6009, Western Australia, Australia.
matt.garas01@gmail.com
Received: July 11, 2024
Revised: September 26, 2024
Accepted: October 21, 2024
Published online: March 18, 2025
Processing time: 139 Days and 5.7 Hours
BACKGROUND
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Liver transplantation (LT) offers the most effective treatment. HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC. The rate of HCC recurrence is generally reported as 8%-20% in the literature. Many predictors of HCC have already been researched, however, to our knowledge there are no published studies on this topic using Australian data.
AIM
To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.
METHODS
We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021. Data was collected from various health record databases and included recipient demographics, serum biochemistry, radiology, operation notes, explant histopathology and details of recurrence. Overall survival of HCC patients post-LT, stratified for recurrence, was calculated by Kaplan Meier analysis. Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.
RESULTS
Between 1/1/2006 and 12/31/2021, 119 patients were transplanted with HCC. 8.4% of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years. The median time to recurrence was 2.9 years ± 0.75 years. When comparing baseline characteristics, a greater proportion of subjects with recurrence had common characteristics on explant histopathology, including > 3 viable nodules (P = 0.001), vascular invasion (P = 0.003) and poorly differentiated HCC (P = 0.03). Unadjusted survival curves showed lower 1-year, 3-year, 5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence (90% vs 92%, 70% vs 88%, 42% vs 80%, 14% vs 76%, respectively; log rank P < 0.001).
CONCLUSION
HCC recurrence was low at 8.4% in this contemporary Australian cohort, however it significantly impacted post-LT survival. Further studies are required to confirm predictors of recurrence and improve recipient outcomes.
Core Tip: This is the first study looking at hepatocellular carcinoma (HCC) recurrence using Australian data. It is well established that HCC recurrence significantly reduces survival post liver transplantation (LT). Optimal selection of candidates to minimize post-LT HCC recurrence remains controversial. The rate of HCC recurrence post-LT in Western Australia is 8.4%. A higher proportion of the patients with HCC recurrence had common baseline characteristics on explant; > 3 tumours, vascular invasion, and poorly differentiated disease. A larger multicentre study is required to investigate the predictive effects of these variables on post-LT HCC recurrence.
