Validation of Risk Estimation of Tumor Recurrence After Transplant Score in Patients With Hepatocellular Carcinoma Treated by Liver Transplant.

Abstract

Recurrent hepatocellular carcinoma can occur after liver transplant in up to 15% of cases. Recurrent hepatocellular carcinoma is associated with a dismal prognosis and subsequently a futile liver transplant in most instances. A validated prognostic scoring system forrecurrent hepatocellular carcinoma that combines both pretransplant factors and explant characteristics has not been available until lately. The Risk Estimation of Tumor Recurrence After Transplant ("RETREAT") score was recently validated. In this study, we analyzed this score for patients treated by liver transplant at our institution. Between August 2006 and December 2019, 73 adult patients within Milan criteria underwentlivertransplantfor hepatocellular carcinoma at our center. Follow-up ranged from 24.3 to 149.9 months with a mean of 45.98 ± 33.3 months. The overall 5-year patient survival, graft survival, and tumor-free survival rates were 78.6%, 90.1%, and 86.3%, respectively. Recurrent hepatocellular carcinoma cases exclusively occurred in patients with score of 3 or more points, with incidence increasing from 0% in those who had scores of ≤2 points to 30.8% in those who had scores of 3 to 5 points and to 66.7% in those who had >5 points (P < .001). The Risk Estimation of Tumor Recurrence After Transplant ("RETREAT") score predicted the occurrence of recurrent hepatocellular carcinoma in our patients and correlated significantly with its incidence. Patients with scores of >5 points were at a very high risk for recurrent hepatocellular carcinoma and should be closely monitored using laboratory and magnetic resonance imaging.