Changing Paradigm in the Surgical Management of Hepatocellular Carcinoma With Salvage Transplantation

Abstract

Objective: The objective of this study was to compare the long-term outcomes of primary and salvage liver transplantation for patients with hepatocellular carcinoma (HCC). Method: This was a 10-year retrospective analysis in a tertiary referral center. Results: There were 184 patients recruited (primary liver transplantation [pLT]:salvage liver transplantation [sLT], 143:41). The median follow-up time was 79 months. Operation time was shorter in the pLT group than the sLT group (661 ± 164 minutes vs 754 ± 206 minutes; P =.01) and the blood loss was 3749 mL and 3545 mL for pLT and sLT, respectively (P =.735). The reoperation rate was 5.6% and 4.9%, respectively (P = 1.0). The 5-year overall and disease-free survival rates from the time of transplantation for pLT and sLT were 84.1% versus 70.2% (P =.01) and 82.2% versus 65.8% (P =.01), respectively. The 5-year overall survival rate from the time of primary treatment for sLT was 80.3% (P =.1). Subgroup analysis of sLT showed that young age (50 vs 56 year old; P =.004) was the only factor associated with poor overall survival. Young age (P =.004) and microvascular permeation (P =.008) in the recurrent tumor were associated with HCC recurrence. Young age stands out to be the only independent factor associated with HCC recurrence. Conclusion: sLT is the treatment of choice for patients with recurrent HCC in regions of graft shortage.