Published online Mar 18, 2025. doi: 10.5500/wjt.v15.i1.99004
Revised: September 26, 2024
Accepted: October 21, 2024
Published online: March 18, 2025
Processing time: 139 Days and 5.7 Hours
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Liver transplantation (LT) offers the most effective treatment. HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC. The rate of HCC recurrence is generally reported as 8%-20% in the literature. Many predictors of HCC have already been researched, however, to our knowledge there are no published studies on this topic using Australian data.
To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.
We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021. Data was collected from various health record databases and included recipient demographics, serum biochemistry, radiology, operation notes, explant histopathology and details of recurrence. Overall survival of HCC patients post-LT, stratified for recurrence, was calculated by Kaplan Meier analysis. Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.
Between 1/1/2006 and 12/31/2021, 119 patients were transplanted with HCC. 8.4% of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years. The median time to recurrence was 2.9 years ± 0.75 years. When comparing baseline characteristics, a greater proportion of subjects with recurrence had common characteristics on explant histopathology, including > 3 viable nodules (P = 0.001), vascular invasion (P = 0.003) and poorly differentiated HCC (P = 0.03). Unadjusted survival curves showed lower 1-year, 3-year, 5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence (90% vs 92%, 70% vs 88%, 42% vs 80%, 14% vs 76%, respectively; log rank P < 0.001).
HCC recurrence was low at 8.4% in this contemporary Australian cohort, however it significantly impacted post-LT survival. Further studies are required to confirm predictors of recurrence and improve recipient outcomes.
Core Tip: This is the first study looking at hepatocellular carcinoma (HCC) recurrence using Australian data. It is well established that HCC recurrence significantly reduces survival post liver transplantation (LT). Optimal selection of candidates to minimize post-LT HCC recurrence remains controversial. The rate of HCC recurrence post-LT in Western Australia is 8.4%. A higher proportion of the patients with HCC recurrence had common baseline characteristics on explant; > 3 tumours, vascular invasion, and poorly differentiated disease. A larger multicentre study is required to investigate the predictive effects of these variables on post-LT HCC recurrence.