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Bhangui et al. Hepatoma Res 2020;6:71 I http://dx.doi.org/10.20517/2394-5079.2020.67 Page 3 of 15

Figure 1. Patient Cohort

Study cohort
From our prospectively maintained database of 2,363 LDLT’s (2005 to mid 2018 so as to have a minimum
follow up of 2 years post LDLT at the time of data analysis), we studied outcomes in 435 histologically
confirmed (on the explant specimen) cirrhosis and HCC (HCC-cirr) patients (18.4% of all LDLTs
performed during this period). During this period, 481 LDLT’s were performed in HCC-cirr patients.
Forty-six had segmental or lobar portal vein tumour thrombosis, and underwent downstaging before LDLT
[18]
as per our Institutional protocol . Those 46 patients were excluded from this study. Hundred patients
developed recurrence, and their management and outcomes were further analysed [Figure 1].

Post LDLT immunosuppression and follow up
Post LDLT, patients were maintained on the standard 3 drug immunosuppressive regimen consisting of
CNI inhibitor (Tacrolimus or cyclosporine), mycophenolate mofetil and steroid, the doses of which were
slowly tapered, and steroid and mycophenolate were gradually omitted (usually by 6 months and 2 years,
respectively). Since 2014, we followed a policy of early switch to mTOR inhibitor based immunosuppression
with CNI reduction, 4-6 weeks after LDLT.

In addition to the routine follow up of all transplanted patients, follow up for tumour recurrence in HCC-
cirr patients included USG and AFP level at 3 months and 6 months, then once every 6 months till 2 years
after LT. After this USG and AFP were repeated once annually. MDCT abdomen (or PET-scan if the
tumours were initially PET-avid) was done 6 monthly for the first two years after LDLT, and then yearly.