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Survival and recurrence rates comparisons in both the this result, many authors such as Belghiti et al. suggested
[10]
groups that liver resection should be the first line of treatment,
The two recurrences occurred in the salvage transplant followed by salvage transplantation for recurrence. They
group that exhibited extrahepatic metastasis. In the primary also showed that 3- and 5-year survival rates were not
transplant group, total of 12 recurrences were noted. In two different between primary transplantation and salvage
cases the recurrence was intrahepatic, and 10 were extrahepatic transplantation. However, Bozorgzadeh et al. showed that
[11]
metastasis. One, 3 and 5 years recurrence-free survival rates survival outcome for transplantation for HCC associated with
were 72%, 72% and 46% in the salvage transplant group, and HCV were significantly lower than for other etiology. Chirica
91%, 73% and 46% in the primary transplant group respectively. et al. suggested that overall and disease-free survival after
[6]
The difference was not significant statistically (P = 0.328 on liver resection for HCV-related HCC is poor and so primary
Log-rank analysis). One-year recurrence-free survival was low LT should be offered to these patients. However Cucchetti
in salvage transplant group, but it did not achieve statistically et al. suggested good outcomes after liver resection for
[12]
significant level (P = 0.08 for 1 year). Kaplan-Meier survival HCV patients.
curves were shown in Figure 1. One, 3 and 5 years survival
rates were 76%, 76% and 65% in salvage transplant group, and The aim of our study was to analyze feasibility of salvage
92%, 85% and 85% in primary transplant group. Kaplan-Meier transplantation for HCC associated with HCV etiology. In this
survival curves were prepared and Log-rank analysis was study both the salvage transplant and the primary transplant
done [Figure 2]. One, 3 and 5 years survival rates were groups were comparable however the primary transplant
significantly lower in salvage transplant group (P = 0.031). group had significantly higher pre-operative MELD scores
as well as CTP scores. MELD scores and CTP scores were not
Analysis of prognostic factors significantly associated with survival or recurrence at any
Prognostic factors were evaluated in all 109 patients. step of the analysis. There were no differences with regard
On the log-rank analysis, on univariate analysis high to pre-operative viral load and pre-operative treatment taken
MELD score (P = 0.01), no pre-transplant interferon between two groups.
therapy (P = 0.002), salvage transplant, no prior transarterial
chemoembolization (TACE) (P = 0.03) were associated with In our study, there was not statistical significant difference
worse survival rates. On multivariate Cox regression analysis in recurrence-free survival between salvage transplant
salvage transplantation (P = 0.04) and no pre-transplant and primary transplant group. However, 1-, 3- and 5-year
TACE (P = 0.02) were independently associated with worse overall survival rates were significantly lower in the
survival rates. Higher AFP levels were associated with worse salvage transplant group. These results indicate that
recurrence-free survival (P = 0.005). primary transplant may be a better treatment strategy for
transplantable HCC in case of associated HCV etiology. Adam
DISCUSSION et al. also showed inferior overall and recurrence-free
[13]
survival in the salvage transplant group. However, they did
Poon et al. suggested that 80% of the intrahepatic not study HCV etiology separately. Belghiti and Durand
[9]
[14]
recurrences after resection are transplantable. Based on in their editorial mentioned that in the study by Chirica

Figure 1: Recurrence free survival salvage transplant vs. primary transplant Figure 2: Overall survival in salvage transplant vs. primary transplant
(Log rank test P = 0.328) (Log rank test P = 0.03)

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