Abstract
PurposeThe prognosis for recipients with hepatocellular carcinoma (HCC) of salvage liver transplantation (SLT) versus those of primary liver transplantation (PLT) remains controversial. The objective of this study was to evaluate the clinical features and survival rate of SLT recipients.MethodsThree hundred seventy-one patients with HCC transplanted at Shanghai General Hospital, China, between October 2001 and October 2011 were separated into PLT (n = 295) and SLT (n = 76) groups. Patient characteristics and survival curves were studied by univariate and multivariate analysis. A Milan criteria-stratified survival analysis was conducted.ResultsThe proportions of reoperation (11.8 vs. 5.4 %, P = 0.047) and early postoperative mortality (11.8 vs. 4.7 %, P = 0.032) were higher in the SLT group than in the PLT group. Recurrence free survival (RFS) rate and overall survival (OS) rate had no statistically significant differences after stratification using Milan criteria between the PLT group and SLT group. Alphafetoprotein >400 ng/mL (P = 0.011), microscopic vascular invasion (MVI) (P < 0.001), tumor node metastasis (TNM) staging (P = 0.006), and out of Milan criteria (P < 0.001) were independent risk factors for RFS, while MVI (P < 0.001), TNM staging (P = 0.009), and out of Milan criteria (P = 0.003) were factors for OS. In the multivariate logistic regression analysis, HCC recurrence was associated with MVI (OR = 4.196 [2.538–6.936], P < 0.001), and out of Milan criteria (OR = 2.704 [1.643–4.451], P < 0.001).ConclusionsOur retrospective, single-center study demonstrated that SLT increases surgical difficulty; however, it has good post-transplantation OS and is a feasible alternative after HCC recurrence within Milan criteria.
Highlights
The percentage of patients with Child–Pugh B, C was higher in the primary liver transplantation (PLT) group than in the Salvage liver transplantation (SLT) group (P = 0.002)
In our single-center retrospective study, we demonstrated that overall survival (OS) and Recurrence free survival (RFS) of SLT recipients was not different from those of PLT recipients within Milan criteria, even though SLT increases surgical difficulties and risks
Another recent study conducted by Guerrini (2014) demonstrated that SLT achieved good post-transplantation survival, but the outcome of SLT remains inferior to PLT in the intention-to-treat analysis
Summary
Hepatocellular carcinoma (HCC) is the seventh most common cancer and the third leading cause ofWang et al SpringerPlus (2016) 5:1809 radiofrequency ablation, and transcatheter hepatic arterial chemoembolization, the prognosis remains generally poor, leading to 500,000 deaths per year (Maluccio and Covey 2012).Liver transplantation (LT) is advisable in patients with HCC and decompensated cirrhosis with excellent results in terms of overall and recurrence-free survival (OS and RFS, respectively) in selected patients (Mazzaferro et al 1996; Befeler et al 2005; Lee et al 2010); organ shortage is a worldwide problem, especially in China, because of the large population base, people’s financial situation, and legal limitations. Salvage liver transplantation (SLT) is a protocol that offers LR first and subsequent liver transplantation for tumor recurrence or deteriorating liver function (Majno et al 2000). Solitary HCC and with preserved hepatic function, it has been reported that SLT has a long-term survival rate similar to that of those who directly undergo primary liver transplantation (PLT) (Majno et al 2000; Cherqui et al 2009; Wu et al 2012; Hu et al 2012). SLT, which reduces the risk of HCC progressing during the time awaiting transplantation, might offer a good strategy for relieving patients with a good prognosis and alleviate the burden on the donor organ pool (Wu et al 2012; Fan et al 2011)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
