Outcomes of extrahepatic recurrence after adult living donor liver transplantation for hepatocellular carcinoma

Abstract

Introduction: A few studies have been reported on extrahepatic metastasis after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). We investigated the clinical outcomes of patients with extrahepatic recurrence (EHR) of HCC after LDLT. Method: We retrospectively reviewed 353 patients who underwent LDLT for HCC from March 2005 to December 2015. Clinicopathological data of patients with EHR were analyzed for overall survival (OS) rate and prognostic factors. Result: During a median follow-up of 25.3 months, a total of 71 patients (71.7%) presented EHR as an initial recurrence. The sites of EHR were lung (n=33), bone (n=10), lymph nodes (n=8), adrenal gland (n=2), and others (n=18). Forty-six patients (64.7%) underwent curative resection for EHR. The 1, 3, 5-year overall survival rate from the time of LDLT in patients with resection for EHR were 90.8%, 59%, and 40.9%, while those in patients without resection for EHR were 56%, 4.7%, and 0% (p <0.05). In multivariate analysis of risk factor for OS, resection for EHR (hazard ratio [HR], 0.254; 95% confidence interval [CI] 0.131–0.495, p = 0.001), interval time from LDLT to EHR (HR 0.950; 95% CI 0.919–0.982, p = 0.002), Alpha-fetoprotein (AFP) ≤200 ng/ml at the diagnosis of EHR (HR 0.323; 95% CI 0.169–0.620, p = 0.001), and the absence of portal vein invasion of HCC in explant liver (HR 0.328; 95% CI 0.171–0.630, p = 0.001) were favorable factors. Conclusion: Resection for EHR after LDLT can be performed in selected patients with a favorable outcome. The longer interval time from LDLT to HER, a lower AFP at EHR, and the HCC without portal vein invasion in explant liver were favorable factors for OS of patients with EHR.