Curative Salvage Liver Transplantation in Cirrhotic patients with Hepatocellular Carcinoma: An intention-to-treat analysis

ABSTRACT

The salvage liver transplantation (SLT) strategy was conceived for initially resectable and transplantable (R&T) hepatocellular carcinoma (HCC) patients, to try to obviate upfront LT, with the 'safety net' of SLT in case of post-resection recurrence. The SLT strategy is successful or curative when patients are recurrence-free following primary resection alone, or after SLT for recurrence. The aim of the current study was to determine the SLT strategy's potential for cure in R&T HCC patients, and to identify predictors for its success.

From 1994-2012, all R&T cirrhotic HCC patients were enrolled in the SLT strategy. An intention-to-treat (ITT) analysis was used to determine this strategy's outcomes and predictors of success according to the above definition.

In total, 110 patients were enrolled in the SLT strategy. Sixty-three patients (57%) had tumor recurrence after initial resection, and in 30 patients SLT could be performed (recurrence transplantability rate=48%). From the time of initial resection, ITT 5-year overall and disease-free survival rates were 69% and 60%, respectively. The SLT strategy was successful in 60 patients (56%), either by resection alone (36%), or by SLT for recurrence (19%). Pre-resection predictors of successful SLT strategy at multivariate analysis included model for end-stage liver disease (MELD) score >10, and absence of neoadjuvant transarterial chemoembolization (TACE). Additional post-resection predictive factors were absence of post-resection morbidity, and T-stage 1-2 at the resection specimen.

Conclusion: The SLT strategy is curative in only 56% of cases. Higher MELD score at inception of the strategy, and no pre-resection TACE are predictors of successful SLT strategy. This article is protected by copyright. All rights reserved.

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