Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY, 10029, United States.
BACKGROUND & AIMS:
It has been reported that ischemia-reperfusion injury of the liver stimulates outgrowth of micrometastases and adhesion of tumor cells. The aim of this study was to elucidate the impact of ischemia time for hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT).
LT for HCC was performed in 271 between 2004 and 2009. After excluding non-heart-beating or living donor LT, 244 were eligible for this study. Analysis of risk factors for HCC recurrence focused on patients with tumors accompanied by pathological macro-/micro-vascular invasion (MaVi / MiVi) (N=106).
HCC recurred in 29 of 106 (27%). T3 or T4a tumor (American Liver Tumor Study Group modified classification, exceeding Milan criteria), pathological MaVi, AFP>72.6 ng/ml, poor differentiation, WIT⩾42 min, CIT⩾603 min, and large intraoperative transfusion were significantly associated with higher recurrence rate. WIT⩾42 min remained as an independent factor for recurrence by multivariate Cox regression analysis (P<0.001). Prediction formula for recurrence was established by a multivariate discriminant analysis; D = -4.163 + 3.496(AFP>72.6ng/ml) + 3.657(poor differentiation) + 3.796(WIT⩾42min) + 3.202(CIT⩾603min), which categorized the patients into the high- and standard-risk groups (1 and 2). One- and 3-year recurrence rates were 70 and 82% in Group 1, and 5 and 17% in Group 2, respectively (P<0.001).
Ischemia time markedly affected recurrence of HCC after LT, when tumors showed pathological MaVi or MiVi. The prediction model consisting of ischemia time and tumor characteristics clearly discriminated patients requiring particular attention for recurrence of HCC in posttransplant follow-up.