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
Keywords
adrenal gland, adult, bone, cancer patient, cancer recurrence, cancer surgery, cancer survival, clinical assessment, cohort analysis, conference abstract, controlled study, drug combination, excision, female, human, liver cell carcinoma, liver injury, liver transplantation, long term survival, lung, lymph node, major clinical study, male, metastasis, multicenter study, outcome assessment, overall survival, peritoneum, recurrence free survival, surgery
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
