HCC recurrence after Liver Transplantation in Asia vs. Europe: which is the difference?

Abstract

Background: Higher recurrence rates have been reported among Asian patients transplanted for hepatocellular carcinoma (HCC). It is not clear if these results are due to a different biological behavior of the tumor or to a different modality of patient management before liver transplantation (LT). The main aim of the present study is to analyze the prognostic factors for post-LT HCC recurrence in a cohort of Asian and European patients, with the intent to analyze the relative importance of tumor-related and management-related factors. Methods: Two hundred seventy-three HCC patients transplanted from January 1999 to March 2009 were analyzed. Patients were followed up for a period of 2 years. One hundred sixteen patients were transplanted in Queen Mary Hospital, Hong Kong and 157 patients in the three Roman university hospitals. Results: Multivariate analysis revealed four different variables as independent risk factors for HCC recurrence: poor grading (OR 5.96; p-value 0.004), microvascular invasion (OR 4.73, p-value <0.0001), previous resection (OR 3.92, p-value 0.02) and diameter of the largest tumor (OR 1.32, p-value 0.007). Patients who underwent LT in Europe were found to have a low risk to develop recurrence (OR 0.24; p-value 0.008) (Figure 1). When patients who underwent resection of the tumor prior to LT were excluded from the analysis, it was seen that only tumorrelated variables were found to be the independent risk factors for recurrence. Patients transplanted in Europe did not show any statistical significance (p-value 0.053); also survival curves loosed their statistical significance (Figure 2). Conclusions: Salvage LT performed after HCC recurrence seems to be the main cause for the worse results in the Asian group of patients.