Parul D Agarwal* and Michael R Lucey
Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, USAFulltext PDF
Despite careful selection for Liver Transplantation (LT) of patients with Hepatocellular Carcinoma (HCC), HCC may still recur after LT and is frequently associated with dismal outcome. Tumor factors, including serum Alpha-Fetoprotein (AFP), the presence of microvascular invasion, tumor grade/differentiation, and largest tumor size are amongst the most important predictors of
recurrence after transplantation. The nature of recurrence can be highly variable, but often presents with extra-hepatic involvement. As such, management of patients with HCC can be challenging, and consensus guidelines are lacking. Curative options, with surgery or ablation, which may be applicable in patients with isolated intra- or extra-hepatic metastases, offers the best chance for improved long-term outcome in patients with HCC recurrence after transplantation. Most patients with recurrence have unresectable disease, and may benefit from palliative treatments, including intra-arterial therapies and/or systemic therapy.
Alpha fetoprotein; Ablation; Trans-arterial chemoembolization; Chemotherapy
Agarwal PD, Lucey MR. Management of Hepatocellular Carcinoma Recurrence after Liver Transplantation. Clin Oncol. 2021;6:1831..