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Original Article

Salvage transplantation for post-resection recurrence in
Salvage transplantation for post-resection recurrence in
hepatocellular carcinoma associated with hepatitis C virus
hepatocellular carcinoma associated with hepatitis C virus
etiology: a feasible strategy?
etiology: a feasible strategy?

1
Bhavin Bhupendra Vasavada , Chao-Long Chan 2
1 Department of Surgical Gastroenterology, HPB Surgery and Liver Transplant, Apollo Hospital, Ahmedabad 380006, Gujarat, India
2 Liver Transplant Program, Chang Gung Memorial Hospital, Taoyuan 33378, Taipei, China

ABSTRACT
Aim: The aim was to analyze the feasibility of salvage liver transplant after liver resection in hepatocellular carcinoma (HCC)
with hepatitis C virus (HCV) etiology. Methods: All the patients diagnosed with HCC with HCV etiology who underwent
living donor liver transplant from July 2002 to November 2012 were studied. Their recurrence rate, mortality, and prognostic
factors were analyzed and compared between primary transplant and salvage transplant for up to 5 years post-transplant.
Results: One hundred and nine patients underwent a liver transplant for HCC associated with HCV etiology within the
University of California, San Francisco criteria. Eighteen were post-hepatectomy salvage transplants and 91 were primary
transplants. Median follow-up time was 31 months. One, 3 and 5 years overall survival rates were 76%, 76% and 65% in
the salvage group, and 92%, 85% and 85% in primary transplant group respectively. The difference in overall survival rates
was statistically signifi cant (P = 0.031). However, recurrence-free survivals for 1, 3 and 5 years were 72%, 72% and 46%
for salvage group, and 91%, 73% and 46% for primary transplant group; which were not statistically signifi cant (P = 0.328).
Conclusion: Salvage transplantation for post-hepatectomy recurrence for patients with HCC associated with HCV-related
chronic liver disease seems to offer inferior overall survival rates than primary transplantation.

Key words: Hepatitis C virus; hepatocellular carcinoma; salvage transplantation.

Address for correspondence:
Dr. Bhavin Bhupendra Vasavada, Department of Surgical Gastroenterology, HPB Surgery and Liver Transplant, Apollo Hospital,
Ahmedabad 380006, Gujarat, India. E-mail: bhavu279@gmail.com
Received: 24-09-2014, Accepted: 23-01-2015

INTRODUCTION also serve as a bridge to liver transplantation. Many authors
[3]
have suggested that results of salvage transplantation are
Hepatocellular carcinoma (HCC) is the most common comparable to primary transplantation. [4,5] However, there
primary malignancy of the liver. There is an ongoing debate also is controversy over management of HCC associated
[1]
about what is the best strategy to treat HCC, particularly with hepatitis C virus (HCV) related cirrhosis. Chirica et al.
[6]
in Child A cirrhosis, when the primary option is resection suggested that overall and disease-free survival after liver
and transplantation. Some reports have suggested that
transplantation is a better choice, but the opponents of resection for HCV-related HCC is poor and so primary liver
[2]
this approach suggest that resection is better because it can transplantation (LT) should be offered to these patients. In
this study, we evaluated feasibility of salvage transplantation
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The aim of this study was to compare the survival
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rates and recurrence rates of primary as well as salvage
transplantation and also to evaluate prognostic factors
DOI:
10.4103/2394-5079.152916 affecting survival and recurrence in primary as well as
salvage transplantation.

36 Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015