Single-center experience of long-term survival outcome between primary liver transplantation and hepatic resection with consequent salvage transplantation for hepatocellular carcinoma within Milan Criteria

Abstract

Background: Whether primary liver transplantation (PLT) is superior to the upfront hepatic resection (HR) and salvage liver transplantation (SLT) for hepatocellular carcinoma (HCC) within Milan criteria is debatable. Aim of study: To compare the long-term survival rates of patients with HCC within Milan criteria undergoing PLT with those undergoing HR + SLT. Patients and methods: Patients with HCC within Milan criteria underwent PLT (n = 149) or HR + SLT (n = 26) were analyzed retrospectively from a prospective database. Patients' demographic characteristics, short-term and long-term outcome measures were compared between 2 groups. Results: Patients' demographic characteristics and tumor status were comparable between 2 groups. PLT group has significantly higher MELD score than HR + SLT group. More patients in HR + SLT group (80.7%) received living donor liver transplantation than those in PLT group (61.7%). Nevertheless, the graft weight to recipient standard liver volume was similar between groups. Hospital mortality was 2.6% in PLT group and 0% in HR + SLT group. The postoperative complication rate was comparable between groups. With median follow-up of 55 months, overall tumor recurrence rate was lower in PLT group (7.9%) than HR + SLT group (26.9%). The 1-year, 3-year and 5-year overall survival rates for PLT group and HR + SLT group were 96%, 89.9%, 96.7% and 100%, 92.3%, 76.9%, respectively. (P = 0.110) On multivariate analysis, Preoperative serum alpha fetoprotein level and microvascular tumor invasion were independent poor prognostic factors for overall survival. Conclusion: Both PLT and HR + SLT are effective treatment modalities for early stage HCC in terms of similar overall survival rate. However, tumor recurrence is significant high in HR + SLT group. Better patient selection in terms of those with favorable tumor characteristics is warrant in patients undergoing SLT for recurrent HCC.