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Implications for Salvage Liver Transplant

Kelvin K. Ng, PhD, FRCSEd(Gen); Chung Mau Lo, MS, FRCS(Edin), FACS; Chi Leung Liu, MS, MD, FRCS(Edin), FACS; Ronnie T. P. Poon, MS, FRCS(Edin), FACS; See Ching Chan, MS, FRCS(Edin); Sheung Tat Fan, MS, MD, PhD, FRCS(Glasg), FRCS(Edin), FACS

Arch Surg. 2008;143(1):68-74.

Hypothesis  There is no difference in the survival benefit between salvage liver transplant and nontransplant therapies for recurrent hepatocellular carcinoma (HCC).

Design  Retrospective study.

Setting  Tertiary referral center.

Patients  Sixty patients developed transplantable intrahepatic recurrent HCC after curative resection. Twelve patients received salvage liver transplant, whereas 48 received nontransplant therapies, including a second surgical resection, radiofrequency ablation, transarterial chemoembolization, and percutaneous ethanol injection.

Main Outcome Measures  The overall survival rates were compared between the 2 groups. Clinicopathologic variables were evaluated by univariate and multivariate analyses for their influence on overall survival.

Results  There was no significant difference in overall survival rates between the salvage transplant and nontransplant groups. In the nontransplant group, pTNM (pathologic TNM) staging at primary resection and the time from primary resection to tumor recurrence were identified as independent prognostic factors affecting overall survival. These 2 factors carried no prognostic value in the salvage transplant group. Patients in the salvage transplant group with stage II tumors before the primary resection or intrahepatic recurrence within 12 months of the primary resection had significantly better overall survival than did the nontransplant group with corresponding poor prognostic factors.

Conclusions  Patients with transplantable intrahepatic recurrence can be treated effectively by salvage transplant or nontransplant therapies. Salvage transplant may be more beneficial to patients with stage II tumors before the primary resection and those with early intrahepatic recurrence.

Author Affiliations: Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.

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Arch Surg. 2008;143(1):74.
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