Prognostic factors affecting survival after recurrence in adult living donor liver transplantation for hepatocellular carcinoma.

Liver transplantation is regarded as an effective treatment for early hepatocellular carcinoma (HCC). However, some patients experience recurrence and subsequently rapid progression of the disease. We investigated prognostic factors affecting survival after recurrence in patients who underwent adult living donor liver transplantation (LDLT) for HCC. From October 1992 to December 2005, 138 adult patients underwent LDLT for HCC. Among these, 28 patients (20.3%) who suffered recurrence were retrospectively reviewed. Univariate and multivariate analyses were performed to analyze factors affecting survival after recurrence. The median time to recurrence was 7.9 months. The median survival time after recurrence was 11.7 months, and the 1- and 3-year survival rates after recurrence were 52.8% and 15.8%, respectively. Initially, 7 patients (25%) showed multiorgan involvement; however, in the follow-up, 21 patients (75%) had multiorgan involvement. On univariate analysis, a pretransplant alpha-fetoprotein level >1000 ng/mL, major vascular invasion, a poorly differentiated tumor, a time to recurrence < or =6 months, unresectable disease, and bony metastases were related to shorter survival after recurrence. The independent prognostic factors by multivariate analysis were major vascular invasion [hazard ratio (HR) = 7.6], a poorly differentiated tumor (HR = 4.3), unresectable disease (HR = 10.4), and bony metastases (HR = 3.2). Two patients survived more than 36 months. One of them underwent retransplantation and survived for 45 months without additional recurrences. In conclusion, after transplantation, recurrent HCC has a tendency to involve multiple organs, and the prognosis is very poor. However, some patients have a good prognosis, and the appropriate treatment can prolong their survival. If the recurrent lesion is locally controllable, surgical resection should be considered. 2010 AASLD.