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Bhangui et al. Hepatoma Res 2020;6:71 Hepatoma Research
DOI: 10.20517/2394-5079.2020.67

Original Article Open Access

Post liver transplant recurrence in patients with
hepatocellular carcinoma: not necessarily the end of

the road!

Prashant Bhangui, Sanjay Yadav, AS Soin

Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Delhi NCR 122001,
India.

Correspondence to: Dr. Prashant Bhangui, Senior Consultant Hepatobiliary and Liver Transplant Surgeon, Medanta Institute
of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Sector 38, Gurugram, Delhi NCR 122001, India.
E-mails: pbhangui@gmail.com; prashant.bhangui@medanta.org

How to cite this article: Bhangui P, Yadav S, Soin AS. Post liver transplant recurrence in patients with hepatocellular carcinoma:
not necessarily the end of the road! Hepatoma Res 2020;6:71. http://dx.doi.org/10.20517/2394-5079.2020.67

Received: 14 Jul 2020 First Decision: 24 Aug 2020 Revised: 7 Sep 2020 Accepted: 15 Sep 2020 Published: 12 Oct 2020

Academic Editor: Nobuhisa Akamatsu Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Received: First Decision: Revised: Accepted: Published:
Abstract
Science Editor: Copy Editor: Production Editor: Jing Yu Aim: We analysed outcomes using multimodality therapy in patients with hepatocellular carcinoma (HCC)
recurrence post living donor liver transplantation (LDLT).

Methods: Of 2363 LDLT’s performed between 2005 to mid 2018, 435 (18.4%) were for HCC within our expanded
selection criteria (absence of extrahepatic disease and vascular invasion, irrespective of tumor size and number).
Survival after recurrence, and prognostic factors for these patients were studied.

Results: Of 435 LDLT patients, 51% had HCC beyond Milan and 43% beyond UCSF criteria at the time of LDLT.
pre-LT AFP > 100 ng/mL and tumour FDG-18 PET avidity predicted overall survival (OS), whereas pre-LT AFP >
100 ng/mL, UCSF criteria, and FDG-18 PET avidity predicted recurrence-free survival. Hundred patients (23%)
developed HCC recurrence at a median time of 16 months (range 2-108 months) post LDLT. Lungs (53%), liver
(37%), and bone (21%) were the most common sites of recurrence. Ninety-five patients received tyrosine kinase
inhibitors (TKI) after recurrence and 62 received mTOR inhibitors (protocol-based after LDLT, or post recurrence).
Surgical resection of metastases was performed in 14 patients, 15 received stereotactic body radiotherapy, and
18 underwent ablation (radiofrequency, microwave ablation, transarterial chemoembolisation, or percutaneous
ethanol injection). One- and 3-yr OS after recurrence were 57%, and 24% respectively, with a maximum post
recurrence survival of 7.5 years. HCC recurrence within one year after LDLT (P = 0.004, HR = 2.38, 95%CI: 1.325-

© 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
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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