Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy

Objective: To compare post-orthotopic liver transplantation(OLT) survival rates between patients with recurrent HCC after partial hepatectomy and those with de novo OLT for HCC, and to screen for the risk factors associated with post-OLT mortality. Methods: From July 2003 to August 2005, 77 consecutive HCC patients underwent OLT, including 15 patients with recurrent HCC after partial hepatectomy for tumor resection (the rescue OLT group) and 62 patients with de novo OLT for HCC (the de novo OLT group); the post-operation survival rates were compared between the 2 groups. Thirty-three demographic, clinical, histological, laboratory and intra- and post-operative variables were analyzed. Cox proportional hazards regression model were used to screen for the factors associated with the survival rate. Results: The median age of the patients was 48.6 years and the median follow-up period was 20 months. Three patients(20.0%) in the rescue OLT group and 15 patients (24.2%) in the de novo OLT group died during follow-up(P=0.73). The 30 day-mortality of OLT was 6.7% for the rescue OLT group vs. 1.6% for the de novo OLT group(P=0.27). Cox proportional hazards model showed that the presence of pre-OLT hyperbilirubinemia, requirement of post-OLT transfusion, size of the largest tumor, tumor macroembolism and family history of HCC were significantly associated with a higher hazard for mortality. Conclusion: No significant difference is found in the survival rates between OLT as de novo therapy and OLT as a rescue therapy for patients with HCC. Pre-OLT hyperbilirubinemia, post-OLT requirement of transfusion, size of the largest tumor, tumor macroembolism, and family history of HCC are associated with a poor survival outcome.