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Simsek et al. Hepatoma Res 2020;6:11 I http://dx.doi.org/10.20517/2394-5079.2019.51 Page 3 of 10

Figure 1. Overall, rate of deceased donor liver transplant for hepatocellular carcinoma indication at the Johns Hopkins Hospital from 2005
to 2015. HCC: hepatocellular carcinoma

hepatitis C (positive hepatitis C antibody and/or hepatitis C RNA) in 13 patients (50%) and hepatitis C and
alcoholic liver disease in 6 (23%) patients. Chronic hepatitis B (positive hepatitis B surface antigen and/or
hepatitis B DNA) was seen in three patients (11.5%), followed by alcoholic liver disease (n = 2, 7.7%), and
non-alcoholic fatty liver disease (n = 1, 3.9%).

Laboratory results
The average model for end-stage liver disease (MELD) score was 13, ranging from 6 to 35. Mean AFP was
27.6 ng/mL for pre-LT vs. 23.6 ng/mL for post-LT time periods [Tables 1 and 2]. Four patients had pre-LT
AFP levels of > 1000 ng/mL. The other available laboratory results are summarized in Table 1.

Immunosuppression
Overall, nine (34.6%) patients were treated with mammalian target of rapamycin (mTOR) treatment with
sirolimus in eight and everolimus in one patient. Seventeen patients received Tacrolimus-based therapy.

Explant-pathology findings
In the explant pathologies of LT recipients, 9 (34.6%) patients had only one lesion and 11 (42.4%) had 4
or more lesions. The average for the largest lesion size was 4.3 cm. In total, 12 patients (46.1%) had multi-
lobar tumors and 13 (50%) had tumors that were located in the right lobe. Overall, 10 patients (38.4%)
were within MC criteria and 11 patients (42.3%) were within UCSF criteria. Four patients (15.4%) were
downstaged to MC with locoregional treatment. Seventeen (65.4%) patients underwent locoregional
therapy before transplant. None of the tumors were well-differentiated. Overall, 14 (53.8%) patients had
moderately differentiated HCC. Eleven (42.3%) patients had HCC with poor differentiation. Microvascular
invasion was detected in 19 of the 26 cases (73.1%) while one patient had bile duct invasion only.

Recurrence and survival
The overall rate of HCC recurrence following LT in our series was 15%. The rate of HCC recurrence has
improved over the years with a recurrence rate of 10% in 2015 [Figure 2]. Mean time for diagnosis of