The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma.

Matteo Serenari,Marc-Antoine Allard,Matteo Ravaioli,Nicolas Golse,Daniel Cherqui,Michele Paterno,Enrico Prosperi,Matteo Cescon,Andrea Laurenzi,René Adam

doi:10.3390/cancers13102398

Abstract

Simple SummaryRecurrence of disease or worsening of liver function after hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a history of HR is supposed to increase the surgical complexity of LT. This is one of the largest series of SLT and it demonstrates that among all the features analyzed regarding the prior HR, only time interval between HR and SLT was an independent predictor of severe complications after SLT. In particular, an increasing probability of severe complications was observed in those patients who were transplanted close (<15 months) to the HR. There was no significant association between HCC-related death and the time between HR and SLT at the multivariable competing risks regression model. Furthermore, these results remained inside the benchmark values recently reported for LT, confirming that tertiary referral centers with consistent experience in HPB surgery and LT may have benefits in both fields.Hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a previous HR is supposed to worsen post-SLT outcomes. Data of patients treated by SLT between 2000 and 2018 at two tertiary referral centers were analyzed. The primary outcome of the study was to analyze the impact of HR on post-LT complications. A Comprehensive Complication Index ≥ 29.6 was chosen as cutoff. The secondary outcome was HCC-related death by means of competing-risk regression analysis. In the study period, 140 patients were included. Patients were transplanted in a median of 23 months after HR (IQR 14–41). Among all the features analyzed regarding the prior HR, only time interval between HR and SLT (time HR-SLT) was an independent predictor of severe complications after LT (OR = 0.98, p < 0.001). According to fractional polynomial regression, the probability of severe complications increased up to 15 months after HR (43%), then slowly decreased over time (OR = 0.88, p < 0.001). There was no significant association between HCC-related death and time HR-SLT at the multivariable competing risks regression model (SHR, 1.06; 95% CI: 0.69–1.62, p = 0.796). This study showed that time HR-SLT was key in predicting complications after LT, without affecting HCC-related death.

Highlights

Surgical treatment of hepatocellular carcinoma (HCC) remains a valid option when it can be offered to selected patients with preserved liver function [1,2]
liver transplantation (LT) can be offered in other circumstances following hepatic resection (HR), such as in case of liver function deterioration or adverse histo-pathological features found on the surgical specimen
While the safety of previous HR on the postoperative outcome has been widely described in the literature for repeat hepatectomy [6], how and to what extent HR may affect the outcomes of secondary liver transplantation (SLT) is still unknown

Summary

Introduction

Surgical treatment of HCC remains a valid option when it can be offered to selected patients with preserved liver function [1,2]. Even though primary liver transplantation (PLT) has been demonstrated to offer survival rates comparable to repeat hepatic resection (HR) [3], many concerns have been raised due to the shortage of donors and to the waitinglist dropout rate, limiting the applicability of PLT For this reason, the policy of many centers is to indicate LT whenever HCC recurs after HR, namely salvage LT [4]. LT can be offered in other circumstances following HR, such as in case of liver function deterioration or adverse histo-pathological features found on the surgical specimen (e.g., microvascular invasion, positive resection margins, low grade differentiation) All of these conditions fall under the name of secondary liver transplantation (SLT) [5]. The secondary study outcome was HCC-related death using competing-risk regression analysis

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