Treatment of Recurrent Hepatocellular Carcinoma After Liver Transplantation

In an ever-expanding patient population, liver transplantation provides the best hope for long-term survival for many patients suffering from hepatocellular carcinoma (HCC) in the setting of cirrhosis. One study has even demonstrated superior 1- and 3-year survival rates for patients undergoing transplantation for HCC versus patients without HCC.1 Because of the shortage of deceased organ donors, the donor risk in living donor transplantation, the high cost of liver transplantation, and the poor outcomes of patients who develop recurrent HCC after transplantation, restrictive criteria have been widely adopted to minimize the likelihood of recurrence; despite careful selection, however, HCC recurrence remains the most important negative predictor of posttransplant survival and occurs in approximately 10% to 30% of patients. The literature describing the timing and sites of recurrence is summarized in Table 1. By definition, recurrent HCC following transplantation represents metastatic disease from the original tumor that either was not detectable before transplantation or was disseminated at the time of transplantation. Here we examine the treatment of recurrent HCC after transplantation, but we recognize at the outset that there is very limited evidence on which recommendations can be based. Apart from the systemic treatment of recurrent HCC with sorafenib, the evidence currently addressing this issue comprises observational studies and expert opinion (levels C and D).