Post-transplant recurrence patterns after liver transplantation for hepatocellular carcinoma: an international multicenter study
Recommended Citation
Claasen MP, Ivanics T, Montalvá E, Citterio D, Beumer BR, Dhote A, Adam R, Mazzaferro V, Ijzermans JN, Sapisochin G, Polak WG. Post-transplant recurrence patterns after liver transplantation for hepatocellular carcinoma: an international multicenter study. Transplantation 2023; 107(9):51.
Document Type
Conference Proceeding
Publication Date
10-1-2023
Publication Title
Transplantation
Abstract
Background: Recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC) adversely affects post-LT survival. Data on whether certain groups can achieve acceptable survival post-recurrence is limited, especially for patients with lung-only metastasis. We sought to analyse post-LT recurrence patterns in patients transplanted for HCC and to map post-transplant outcomes for patients with lung-only metastasis. Methods: A large international multicenter cohort of patients transplanted for HCC between 2000-2022 was collected. Outcomes evaluated were overall survival (OS) and recurrence-free survival (RFS). Results: A total of 2,583 patients from five different centers were included in the study, of whom 369 (14%) developed recurrence post-LT. Five- and ten-years RFS were 69.9% and 58.4%, respectively. The first site of recurrence included liver-only (n=106 [28.7%]), lung-only (n=66 [17.9%]), bone (n=45 [12.2%]), adrenal gland-only (n=21 [5.7%]), peritoneal-only (n=18 [4.9%]), lymph nodes-only (n=16 [4.3%]), other single-site (n=17 [4.6%]), and multi-organ (n=73 [19.8%]). Overall 1-, 3-, 5-years post-LT and post-recurrence survival in patients that recurred was low (post-LT: 85.1%, 53.3%, 33.2%; post-recurrence: 55.8%, 22.7%, 14.0%). Patients with lung-only metastasis showed better outcomes than average with a 1-, 3-, 5-year OS post-LT of 94.0%, 64.4%, 40.9% and a 1-, 3-, 5-year OS post-recurrence of 76.4%, 40.3%, 24.0%. Thirtytwo (48%) of the patients with lung-only recurrence were treated with surgical resection, of whom 6 received additional treatment. Lung-only recurrent patients receiving surgical resection as singletreatment (n=26) showed significantly better OS post-LT (1-,3-,5-year: 100%, 88.0%, 66.2% vs. 89.7%, 47.9%, 22.6%,p<0.01) and post-recurrence (1-,3-,5-year: 96.2%, 60.4%, 53.7% vs. 62.2%, 24.5%, 0%,p<0.01) than patients receiving non-surgical or combined treatments (n=39). Conclusions: Post-LT recurrence often manifests as single-sited lesions, with liver and lung being the most common sites. Overall survival after recurrence is low, with patients with lung-only recurrence showing better than average survival. When treated with surgical resection, patients with lung-only metastasis can achieve acceptable long-term survival.
Volume
107
Issue
9
First Page
51
