Impact of Single Viable Hepatocellular Carcinoma ≤ 3 cm on Survival After Liver Transplantation

The risks of recurrent hepatocellular carcinoma (HCC) and HCC-specific mortality post-liver transplant (LT) are influenced by the number and size of viable tumours. This study assesses HCC-specific mortality post-transplant for patients in two groups-those with no viable disease versus single viable tumour ≤ 3 cm, as assessed on most recent imaging prior to transplantation.

This retrospective cohort study included adult patients transplanted for the indication of HCC between 1998 and 2018 at two Australian centres. Competing risks regression assessed 5-year HCC-specific mortality, with the competing risk of non-HCC-specific mortality.

There was a significantly lower 5-year HCC-specific mortality post-transplant for those with no viable disease (n = 152) versus single viable tumour ≤ 3 cm (n = 145) (4.0% vs. 10.5%, SHR 2.72, 95% CI: 1.06-6.98, p = 0.038) on univariable analysis. On multivariable competing risks analysis, the modified Response Evaluation Criteria In Solid Tumour (mRECIST) criteria and higher AFP level at transplant were significant predictors of 5-year HCC specific mortality, with progressive disease (aSHR 16.33, 95% CI: 2.35-113.6, p = 0.005) and stable disease (aSHR 10.26, 95% CI: 1.81-58.2, p = 0.0012) having a higher risk than complete response; whilst the significance of no viable disease versus single viable tumour ≤ 3 cm was not significant on multivariable analysis.

There was a significantly lower 5-year HCC-specific mortality for those with imaging showing no viable disease versus single viable tumour ≤ 3 cm, prior to transplantation. Lower HCC-specific mortality was demonstrated for those with a lower AFP level and those in radiological complete response at time of transplant.