Long-Term Survival and Recurrence in HCC vs. Non-HCC Liver Transplant Recipients: A Two-Decade Longitudinal Analysis

We aim to compare the long-term survival outcomes of patients who have received liver transplants (LTs) as a result of primary hepatocellular carcinoma (HCC).

A retrospective registry analysis of the Scientific Registry of Transplant Recipients (SRTR) database was done for LTs that were performed in the United States from January 2000 to June 2023.

A total of 143,717 LT cases have met both the inclusion and the exclusion criteria and were included in the final analysis. The most common primary diagnosis in the non-HCC cohort was hepatitis C virus (HCV) (14,813 cases, 27%), alcoholic cirrhosis (6631 cases, 12.1%) in the 2001-2010 cohort, alcoholic cirrhosis (18,370 cases, 20.7%), and non-alcoholic steatohepatitis (NASH) (13,997 cases,15.8%) in the 2011-2023 cohort. The data analysis showed a significant overall one- and five-year allograft survival improvement in the 2011-2023 time frame compared to the 2001-2010 group in both HCC and non-HCC patients. The allograft survival difference became more significant after the 5 years of follow-up with a 10% difference between the two time frames in both HCC and non-HCC groups. Patients who met and were selected based on Milan's criteria had significantly better outcomes in both cohorts. Five-year allograft and patient survival were also significantly higher in the patients who met Milan's criteria in 2011-2023 cohort, compared to 2001-2010 cohort (74.4% vs. 66.1%, P-value <0.001, and 76% vs. 68.7%, P-value <0.01, respectively). Acute and chronic rejections were significantly higher in the non-HCC groups in both time frames. It was 6.5% vs. 4.8%, P = 0.03 in 2001-2010, and 13.6% vs. 8.2%, P = 0.0007 in 2011-2023, for acute rejection and 10.8% vs. 6.7%, P = 0.0001 in 2001-2010, and 14.1% vs. 10.3%, P = 0.01 in 2011-2023, for chronic rejection.

Short- and long-term outcomes of LT are almost equal to the other causes of liver transplantation in the recent decade, which can significantly overcome the dilemma of doing LT in patients with HCC diagnosis, who need LT. Adhering to the Milan criteria is crucial for optimizing outcomes, as demonstrated by our study's findings, which highlight significantly better allograft and patient survival rates among those who meet these criteria.