Recurrence of Hepatocellular Carcinoma After Liver Transplant: A Single-Center Experience

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OBJECTIVES: Hepatocellular carcinoma is the fourth leading cause of cancer-related mortality worldwide, and almost all patients have simultaneous cirrhosis. For patients with hepatocellular carcinoma concurrent with cirrhosis, the best treatment option is liver transplant. With expansion of transplant criteria and increased use of liver transplant for treatment, median survival and recurrence rates in patients with hepatocellular carcinoma have also increased. Here, we evaluated tumor recurrence characteristics of hepatocellular carcinoma after liver transplant, treatments given, and survival periods. MATERIALS AND METHODS: We retrospectively analyzed data of 512 patients who underwent transplant from January 2000 to December 2023 at Baskent University (Ankara, Turkey). We evaluated recurrence patterns, time to recurrence, and treatment survival outcomes among patients with or without recurrence. RESULTS: Of 204 adult patients, 63 underwent transplant because of hepatocellular carcinoma. Of the 63 patients, 16 (25%) developed recurrence after liver transplant. Only 1 of the patients who developed recurrence was still alive at the time of this report. Of 16 patients, 50% had local and distant recurrence, 31% had distant metastasis, and 19% developed only local recurrence. Among patients, median overall survival was 65 months. Median survival was significantly lower in the recurrent group than in the nonrecurrent group (33 vs 49 mo; P = .001). Median time to recurrence was 11.6 months. Of the 63 patients, 32 patients (50.7%) underwent liver transplant by use of the expanded criteria developed in our center. CONCLUSIONS: Hepatocellular carcinoma requires a multidisciplinary approach. Although advances in interventional radiology, surgery, and medical oncologic treatment have prolonged survival in patients with hepatocellular carcinoma, hepatocellular carcinoma recurrence is still associated with poor prognosis. Management of recurrence remains an issue, with not enough data and single guidelines for management of hepatocellular carcinoma recurrence in immunosuppressed transplant recipients.