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Outcomes of salvage liver transplant for recurrent hepatocellular carcinoma: A comparison with primary liver transplant
Ann Hepatobiliary Pancreat Surg 2019 Feb;23(1):1-7
Published online February 28, 2019;  https://doi.org/10.14701/ahbps.2019.23.1.1
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Yuxin Guo1, Ek-Khoon Tan1, Thinesh-Lee Krishnamoorthy2, Chee-Kiat Tan2, Ban-Hock Tan3, Thuan-Tong Tan3, Ser-Yee Lee1, Chung-Yip Chan1, Peng-Chung Cheow1, Alexander Y. F. Chung1, Prema Raj Jeyaraj1, and Brian K. P. Goh1,4

Departments of 1Hepatopancreatobiliary and Transplant Surgery, 2Gastroenterology and Hepatology, and 3Infectious Disease, Singapore General Hospital, 4Duke-NUS Medical School, Singapore
Received June 13, 2018; Revised October 6, 2018; Accepted October 7, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: Salvage liver transplantation (SLT) is a therapeutic strategy for recurrent hepatocellular carcinoma (HCC). However, it remains controversial with compromised survival outcomes and increased perioperative morbidity compared to primary liver transplant (PLT). In the present work, we describe our institution’s experience on SLT by comparing outcomes of SLT to PLT for HCCs.
Methods: Retrospective analysis was conducted for 49 transplant patients from 2006-2017. A comparative analysis was carried out between 14 SLT patients and 35 PLT patients.
Results: SLT patients demonstrated significantly shorter time to recurrence than PLT patients (median=5.5 versus 23 months, p<0.001) with a trend towards increased perioperative major morbidity (42.9% versus 37%, p=0.711), inferior 5-year overall survival (61% versus 75%, p=0.345) and inferior 5-year recurrence-free survival (57% versus 72%, p=0.263). However, overall survival from the point of primary resection over a 10-year period showed no statistical difference between the 2 groups (SLT=60% versus PLT=61%, p=0.685).
Conclusions: SLT is a viable treatment strategy for HCCs. However, it exhibited poorer short-term perioperative and oncologic outcomes than PLT. SLT requires better patient selection with liver donor grafts for optimization of resource allocation in this era of organ shortage. Considering the worldwide shortages in liver grafts, it is hypothesized that optimization of a salvage transplant strategy may improve resource allocation and reap optimal patient outcomes.
Keywords : Hepatocellular carcinoma; Salvage liver transplantation; Primary liver transplantation; Survival

 

February 2019, 23 (1)