Pre-transplant therapy for hepatocellular carcinoma is associated with a lower recurrence after liver transplantation

Hepatic transplantation has been advocated as an effective treatment for hepatocellular carcinoma (HCC). We seek to determine if pre-transplant therapies can reduce post-transplant recurrence.

We conducted a retrospective review of prospective data in patients undergoing transplantation for HCC 2001-2006. Patients were followed for recurrence every six months with abdominal computerized tomography or magnetic resonance imaging. Logistic regression analyzed recipient factors such as prior treatment for HCC, donor, operative, and tumor factors in comparing patients developing HCC recurrence with those without recurrence.

During the study period, we performed 124 hepatic transplants for HCC [age: 55 +/- 7.6 yr; 104 (85%) male, 81 (66%) white, and 32 (26%) Asian]. Recurrence was found in nine at a mean of 2.6 yr follow-up. Thirty-three patients (27%) had pre-transplant treatment (radiofrequency ablation, transarterial chemoembolization or percutaneous ethanol injection). Univariable logistic regression identified nine factors [body mass index, Asian race, hepatitis B, prior HCC therapy, alpha-fetoprotein (AFP), model for end-stage liver disease (MELD) score, bilirubin, and international normalized ratio] predictive of HCC recurrence at a level of p < 0.1. Multiple logistic regression analysis of six of the nine selected factors demonstrated AFP level >1000, calculated pre-transplant MELD score <14, and the lack of any pre-transplant treatment were significantly associated with recurrence of HCC. No patient with prior HCC therapy had recurrence.

In patients with HCC awaiting hepatic transplantation, there is a reduced rate of recurrence of HCC if tumors are pre-treated with liver-directed therapy. By treating HCC tumors with any type of treatment prior to transplant, we can significantly reduce the odds of HCC recurrence after transplant.