Predicting and Managing Hepatocellular Carcinoma Recurrence After Liver Transplant: A Single-Center Experience...

Area of Science:

• Hepatology
• Transplant Surgery
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality in the US.
• Orthotopic liver transplant (OLT) offers a curative option for selected HCC patients.
• Post-OLT HCC recurrence affects up to 15% of recipients, necessitating effective surveillance.

Purpose of the Study:

• To evaluate the effectiveness of the RETREAT score in predicting post-OLT HCC recurrence.
• To assess outcomes and challenges of managing HCC recurrence post-OLT.
• To determine optimal surveillance strategies for HCC recurrence after OLT.

Main Methods:

• Single-center retrospective analysis of 923 OLT recipients (2012-2024).
• HCC diagnosis confirmed by histology or LI-RADS 5 imaging.
• RETREAT scores calculated for all patients to assess recurrence risk.

Main Results:

• Of 329 HCC patients, 36 (10.9%) experienced post-OLT recurrence.
• Recurrence linked to viable tumor on explant, beyond Milan Criteria, microvascular invasion, larger tumor size, and higher RETREAT scores.
• A significant proportion (one-third) of recurrent cases had low RETREAT scores (0 or 1), limiting its predictive value.

Conclusions:

• Post-OLT HCC recurrence rates and systemic therapy challenges align with existing literature.
• The RETREAT score demonstrated limited sensitivity and negative predictive value for identifying low-risk patients.
• Broad surveillance strategies may be superior to personalized approaches based on low RETREAT scores for post-OLT HCC recurrence.