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Simsek et al. Hepatoma Res 2020;6:11 Hepatoma Research
DOI: 10.20517/2394-5079.2019.51

Original Article Open Access

Recurrence of hepatocellular carcinoma following
deceased donor liver transplantation: case series

Cem Simsek , Amy Kim , Michelle Ma , Nilay Danis , Merve Gurakar , Andrew M. Cameron , Benjamin
3
1
1
2
1
1
Philosophe , Jacqueline Garonzik-Wang , Shane Ottmann , Ahmet Gurakar , Behnam Saberi 1
3
3
1
3
1 Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, MD
21205, USA.
2 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
3 Johns Hopkins University School of Medicine, Division of Transplant Surgery, Baltimore, MD 21205, USA.
Correspondence to: Dr. Ahmet Gurakar, Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine,
720 Rutland Avenue Ross Research Building, Suite 918 Baltimore, MD 21205, USA. E-mail: aguraka1@jhmi.edu
How to cite this article: Simsek C, Kim A, Ma M, Danis N, Gurakar M, Cameron AM, Philosophe B, Garonzik-Wang J, Ottmann S,
Gurakar A, Saberi B. Recurrence of hepatocellular carcinoma following deceased donor liver transplantation: case series. Hepatoma Res
2020;6:11. http://dx.doi.org/10.20517/2394-5079.2019.51
Received: 20 Dec 2019 First Decision: 3 Feb 2020 Revised: 2 Mar 2020 Accepted: 3 Mar 2020 Published: 20 Mar 2020
Science Editor: Guang-Wen Cao Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Aim: We aimed to study the clinical and pathological characteristics of liver transplant recipients with hepatocellular
carcinoma recurrence.

Methods: We reviewed the data for 26 patients who had tumor recurrence after deceased donor liver transplant for
hepatocellular carcinoma at the Johns Hopkins Hospital from January 2005 to December 2015.

Results: In total, 88% of recipients were males. The mean age was 59 years. On explant, poor differentiation was
detected in 43%, while 73% had microvascular invasion. Overall, 62% were diagnosed to be outside of Milan criteria.
Out of these, 15% met the criteria for downstaging. Twenty (77%) patients had pre-transplant alpha fetoprotein levels
≥ 20 ng/mL. In 54% of patients, the location of hepatocellular carcinoma (HCC) recurrence was extrahepatic, followed
by intrahepatic in 31% and both intra- and extrahepatic in 15%. The post-transplant tumor recurrence was diagnosed
at a mean of 427 days (range 34-1502). Fifty percent of HCC recurrences were diagnosed within one year following
liver transplant. Twenty (77%) patients received treatment for their recurrent HCC: external radiation (n = 10), surgical
resections (n = 8; brain 4, spine 2, bone 1, and Whipple surgery 1), sorafenib (n = 7), locoregional therapy (n = 5).
Overall, 24 out of 26 (92%) recipients died within four years after the transplant.

Conclusion: HCC recurrence after liver transplant is infrequent. More than fifty percent of HCC recurrences following
liver transplant are extrahepatic. Despite better recipient selection for liver transplant, the curative options are limited in
recurrent cases and associated with extremely poor outcomes.

Keywords: Hepatocellular carcinoma, liver transplant, liver resection, locoregional therapy
© 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
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