Outcomes of salvage liver transplant for recurrent hepatocellular carcinoma: A comparison with primary liver transplant

• DOI: 10.14701/ahbps.2019.23.1.1
• Publication Date: 2019-03-07T07:08:47Z
• Authors: Yuxin Guo; Ek-Khoon Tan; Thinesh-Lee Krish...; Chee-Kiat Tan; Ban-Hock Tan; Thuan-Tong Tan; Ser-Yee Lee; Chung-Yip Chan; Peng-Chung Cheow; Alexander Y. F. C...; Prema Raj Jeyaraj; Brian K. P. Goh
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Survival; Hepatocellular carcinoma; Primary liver transplantation; 616; 617; Original Article; Salvage liver transplantation; 3. Good health

Salvage liver transplantation (SLT) is a therapeutic strategy for recurrent hepatocellular carcinoma (HCC). However, it remains controversial with compromised survival outcomes and increased perioperative morbidity compared to primary liver transplant (PLT). In the present work, we describe our institution's experience on SLT by comparing outcomes of SLT to PLT for HCCs.Retrospective analysis was conducted for 49 transplant patients from 2006-2017. A comparative analysis was carried out between 14 SLT patients and 35 PLT patients.SLT patients demonstrated significantly shorter time to recurrence than PLT patients (median=5.5 versus 23 months, p<0.001) with a trend towards increased perioperative major morbidity (42.9% versus 37%, p=0.711), inferior 5-year overall survival (61% versus 75%, p=0.345) and inferior 5-year recurrence-free survival (57% versus 72%, p=0.263). However, overall survival from the point of primary resection over a 10-year period showed no statistical difference between the 2 groups (SLT=60% versus PLT=61%, p=0.685).SLT is a viable treatment strategy for HCCs. However, it exhibited poorer short-term perioperative and oncologic outcomes than PLT. SLT requires better patient selection with liver donor grafts for optimization of resource allocation in this era of organ shortage. Considering the worldwide shortages in liver grafts, it is hypothesized that optimization of a salvage transplant strategy may improve resource allocation and reap optimal patient outcomes.