SURVEILLANCE AND MANAGEMENT OF POST-TRANSPLANT HEPATOCELLULAR CARCINOMA RECURRENCE

Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation (LT) worldwide, yet tumour recurrence after LT remains a major limitation to long-term survival. Recurrence occurs in 6-20 % of transplant recipients and is most commonly detected within two to three years after transplant. Early recurrence (< 24 months) has a median post-recurrence survival of 10-13 months. In the absence of universal guidelines, clinicians must navigate a complex landscape of risk factors, prognostic scores, surveillance schedules and therapeutic options. This review synthesises current evidence, including recent consensus statements and clinical trials, to provide a comprehensive, practice-oriented guide for clinicians managing post-transplant HCC recurrence. We describe the pathophysiological mechanisms of recurrence, discuss patient- and tumour-specific risk factors, detail prognostic scoring systems, present risk-stratified surveillance algorithms, review immunosuppression and adjuvant therapies, and outline management strategies for intrahepatic and extrahepatic recurrence. We also highlight future directions in imaging, biomarkers, systemic therapy and precision immunosuppression.