e14602 Background: Although liver transplantation offers excellent recurrence-free survivals for treating hepatocellular carcinoma (HCC), cases with recurrent diseases usually result in miserable outcomes. In this study, the indication and efficacy of surgical resection for the recurrent diseases after living donor liver transplantation (LDLT) for HCC. Methods: A total of 153 recipients, who underwent LDLT for HCC between 1997 and 2011, were included. The endpoints analyzed were survivals from time of LDLT and from the time of recurrence. Results: Twenty-three patients had recurrence of HCC after LDLT. The mean period until the initial recurrence after LDLT and the mean duration until death after the initial recurrence were 17.1 months (n=23) and 17.4 months (n=16), respectively. A univariate analysis showed that gender (p<0.01) des-gamma-carboxy prothrombin <300 mAU/ml (p=0.02), interferon therapy (p=0.02), early posttransplant tumor recurrence (p<0.01), and eligibility for a surgical resection (p<0.01) all had a beneficial impact on survival from tumor recurrence. Other factors at LDLT including Milan criteria, tumor number, tumor size or alpha-fetoprotein had no impact on the survival after recurrence. Multivariate analysis showed eligibility for a surgical resection (odds ratio 12.3, p<0.0199 and des-gamma-carboxy prothrombin <300 mAU/ml (odds ratio 5.3, p=0.04) were the independent beneficial factors on survival from tumor recurrence. Surgical resection was performed in 12 patients for the initial recurrences at lung (n=5), peritoneum (n=2) lymph nodes (n=2), liver (n=1), bone (n=1) and adrenal gland. The 2-year survival rate after recurrence in the patients surgery was indicated or not indicated was 72.2% and 18.2%, respectively (p<0.01). Conclusions: Surgical therapy could be useful for patients who experience a recurrence of HCC after LDLT to improve their outcome, when such treatment is available.
Circulating cancer stem cells in hepatocellular carcinoma: A pilot study of prediction for tumor recurrence after living donor liver transplantation
