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Zhang et al. Hepatoma Res 2017;3:58-66 Hepatoma Research
DOI: 10.20517/2394-5079.2017.05
www.hrjournal.net
Original Article Open Access

Late recurrence of hepatocellular

carcinoma after liver transplantation

Julia A. Zhang , Sandi A. Kwee , Linda L. Wong
1
2
1
1 Department of Surgery, University of Hawaii School of Medicine, Honolulu, HI 96813, USA.
2 The Queens Medical Center, Honolulu, HI 96813, USA.
Correspondence to: Prof. Linda L. Wong, Department of Surgery, University of Hawaii School of Medicine, 550 S. Beretania Street, Suite 403, Honolulu,
HI 96813, USA. E-mail: Hepatoma@aol.com

How to cite this article: Zhang JA, Kwee SA, Wong LL. Late recurrence of hepatocellular carcinoma after liver transplantation Hepatoma Res
2017;3:58-66.
ABSTRACT

Article history: Aim: Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide
Received: 29-01-2017 and liver transplant (LT) prolongs survival. However, 15-20% will experience recurrent HCC,
Accepted: 24-03-2017 most occurring within 2 years of LT. HCC patients with late recurrences (> 5 years after
Published: 10-04-2017 LT) may have distinctive clinical/biological characteristics. Methods: A retrospective review
was conducted of 88 patients who underwent LT for HCC during 1993-2015, analyzing
Key words: demographics, clinical factors, explant pathology, and outcome. Results: Median follow-up
Hepatocellular carcinoma, was 6.4 years. HCC recurred in 15 (17.0%) patients with mean time to recurrence of 3.96 ±
liver transplantation, 3.99 years. Five patients reoccurred > 5 years post-LT. All late recurrences involved males in
recurrence their 50s, recurring at 8.5 years on average. Recurrences occurred in chest wall (2), liver (2),
lung (2), bone (1) and pelvis (1), with multifocal involvement in 2 patients. Four patients died
within 18 months of late recurrence. The fifth patient is alive after ablation of liver recurrence
and treatment with sorafenib and everolimus. Conclusion: One-third of post-LT patients with
recurrent HCC experienced late recurrence. Although the sample size makes it difficult to
identify significant risk factors, this study highlights the importance of long-term follow-up
and need for biomarkers to identify patients at risk for late recurrences.

[2]
INTRODUCTION compared to 10% in untreated HCC. Despite
receiving optimal therapy with transplantation, up to
Hepatocellular carcinoma (HCC) is the most common 20% of patients may experience recurrent HCC. Most
primary liver cancer with 782,000 new cases and of these recurrences occur within 2 years following
[1]
745,000 deaths annually worldwide. The best transplantation. Although there are no clear guidelines
treatments for HCC include liver resection and liver on how to treat these recurrences, surgical resection
transplantation (LT). However, most patients present is the preferred treatment option. Other locoregional
at advanced stage and are not candidates for these therapies such as radiofrequency ablation (RFA)
potentially curative therapies. LT, although limited by and transarterial chemoembolization (TACE) may be
the shortage of donor livers, has superior disease- options, and sorafenib can be considered for more
free survival, with improved 5-year survival of 70% diffuse, unresectable disease. [3,4]

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