Salvage Liver Transplantation Is a Reasonable Option for Selected Patients Who Have Recurrent Hepatocellular Carcinoma after Liver Resection

Zhenhua Hu,Lin Zhou,Jie Zhou,Zhiwei Li,Shusen Zheng,Xiaofeng Xu,Jian Wu,Min Zhang,Yiqing Song

doi:10.1371/journal.pone.0036587

Abstract

BackgroundSalvage liver transplantation (SLT) has been reported as being feasible for patients who develop recurrent hepatocellular carcinoma (HCC) after primary liver resection, but this finding remains controversial. We retrospectively studied the clinical characteristics of SLT recipients and conducted a comparison between SLT recipients and primary liver transplantation (PLT) recipients.Methodology and Principal FindingsA retrospective study examined data from the China Liver Transplant Registry (CLTR) for 6,975 transplants performed from January 1999 to December 2009. A total of 6,087 patients underwent PLT and 888 patients underwent SLT for recurrence. Living donor liver transplantation (LDLT) was performed in 389 patients, while 6,586 patients underwent deceased donor liver transplantation (DDLT). Kaplan-Meier curves were used to compare survival rates. The 1-year, 3-year, and 5-year overall survival of SLT recipients was similar to that of PLT recipients: 73.00%, 51.77%, and 45.84% vs. 74.49%, 55.10%, and 48.81%, respectively (P = 0.260). The 1-year, 3-year and 5-year disease-free survival of SLT recipients was inferior to that of PLT recipients: 64.79%, 45.57%, and 37.78% vs. 66.39%, 50.39%, and 43.50%, respectively (P = 0.048). Similar survival results were observed for SLT and PLT within both the LDLT and DDLT recipients. Within the SLT group, the 1-year, 3-year, and 5-year overall survival for LDLT and DDLT recipients was similar: 93.33%, 74.67%, and 74.67% vs. 80.13%, 62.10%, and 54.18% (P = 0.281), as was the disease-free survival: 84.85%, 62.85%, and 62.85% vs. 70.54%, 53.94%, and 43.57% (P = 0.462).ConclusionsOur study demonstrates that for selected patients, SLT has similar survival to that of PLT, indicating that SLT is acceptable for patients with recurrent HCC after liver resection. Given the limited organ donor pool, salvage LDLT might be considered as a possible treatment.

Highlights

With long-term developments in the management strategy for patients with hepatocellular carcinoma (HCC), considerable experience has been gained in the treatment of HCC patients
Our study demonstrates that for selected patients, Salvage liver transplantation (SLT) has similar survival to that of primary liver transplantation (PLT), indicating that SLT is acceptable for patients with recurrent HCC after liver resection
PLT, while 888 (12.7%) underwent primary liver resection followed by SLT for HCC recurrence

Summary

Introduction

With long-term developments in the management strategy for patients with hepatocellular carcinoma (HCC), considerable experience has been gained in the treatment of HCC patients. Liver resection has been the mainstay of surgical treatment for HCC [1]. Studies have shown superior survival results after transplantation compared with resection, especially in terms of disease-free survival rates [1,5,6,7,8]. In some countries where the availability of liver donors is limited, HCC is still primarily treated with liver resection, or other locoregional therapies [9,10,11,12]. Salvage liver transplantation (SLT) has been reported as being feasible for patients who develop recurrent hepatocellular carcinoma (HCC) after primary liver resection, but this finding remains controversial. We retrospectively studied the clinical characteristics of SLT recipients and conducted a comparison between SLT recipients and primary liver transplantation (PLT) recipients

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