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Toniutto et al. Hepatoma Res 2020;6:50 Hepatoma Research
DOI: 10.20517/2394-5079.2020.40

Review Open Access

Risk factors for hepatocellular carcinoma recurrence
after liver transplantation

Pierluigi Toniutto, Ezio Fornasiere, Elisa Fumolo, Davide Bitetto

Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, Udine 33100, Italy.
Correspondence to: Prof. Pierluigi Toniutto, Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata,
P.zale S.M. della Misericordia 1, Udine 33100, Italy. E-mail: pierluigi.toniutto@uniud.it

How to cite this article: Toniutto P, Fornasiere E, Fumolo E, Bitetto D. Risk factors for hepatocellular carcinoma recurrence after
liver transplantation. Hepatoma Res 2020;6:50. http://dx.doi.org/10.20517/2394-5079.2020.40

Received: 17 Apr 2020 First Decision: 8 Jun 2020 Revised: 3 Jul 2020 Accepted: 13 Jul 2020 Published: 15 Aug 2020

Academic Editor: Guido Guenther Gerken Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Received: First Decision: Revised: Accepted: Published:
Liver transplantation (LT) provides an excellent option for the long-term survival of patients with unresectable
Science Editor: Copy Editor: Production Editor: Jing Yu hepatocellular carcinoma (HCC) based on the Milan criteria. Despite careful selection of patients, HCC may still
recur after LT, which represents the most important negative predictor of post-transplant survival. The growing
demand for LT in HCC has led to the expansion of patient selection criteria, with a resultant increase in the risk of
post-transplant HCC recurrence. Numerous tumor and host factors predict HCC recurrence. The morphological,
histological, and serological characteristics of tumors in predicting HCC recurrence have been extensively studied.
Furthermore, the type and duration of anticancer response before LT has also been considered a surrogate marker
of tumor aggressiveness and is associated with the risk of recurrence. The demographic and clinical characteristics
of recipients, as well as the type and duration of exposure to immunosuppressive therapy, represent the main host-
related risk factors. Many studies have attempted to describe predictive models for the risk of HCC recurrence,
considering evaluable parameters both before and after LT. Although many models have been proposed,
relatively few have been externally validated on different patient populations. This paper aims to comprehensively
summarize the available data on the predictive factors of HCC recurrence after LT, and to examine and discuss
those that have been externally validated.

Keywords: Liver transplantation, hepatocellular carcinoma, tumor recurrence, risk predictive model

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
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