analysis of risk factors for recurrence and metastasis in patients with hepatocellular carcinoma after liver transplantation

Objective: To investigate the features and risk factors for recurrence and metastasis in patients with hepatocellular carcinoma (HCC) after liver transplantation. Methods: Totally 120 patients with HCC undergoing liver transplantation from Jan. 6th, 2012 to Jan. 6th, 2013 were collected from Shandong Chest Hospital. 10 patients were not followed up because of perioperative death, treatment abandoning due to disease deterioration or patients’ withdrawal from treatment. The other 110 patients were followed up. According to follow-up results and recurrence condition, patients were divided into group A (recurrent patients) and group B (non-recurrent patients). The features of recurrence and metastasis of HCC after transplantation were analyzed and concluded.Results: Patients were followed up for 2-34 months and the median follow-up time was 16 months. 58 recurrent patients had 102 recurrent and metastatic sites, including 58 (56.86%) cases in lung, 25 (24.51%) cases in bone, 13 (12.75%) cases in graft liver, 2 (1.96%) cases in abdominal wall, 1 (0.98%) cases in brain, 2 (1.96%) cases in celiac lymph nodes and 1 (0.98%) cases in pleura. The recurrent time was 3-22 months after liver transplantation and the median time was 6.5 months. 29 patients recurred within 6 months, 18 patients recurred during 6-12 months, and 10 patients recurred after 12 months. The number of tumor, tumor diameter, TNM staging, level of alpha fetal protein (AFP) before liver transplantation and vascular invasion were the relevant factors for the recurrence of HCC after transplantation; The tumor diameter (>5 cm), level of AFP before liver transplantation (≥400 μg/L) andvascular invasion were the independent risk factors for the recurrence of HCC after liver transplantation.Conclusion: Patients with vascular invasion, the diameter >5cm, the level of AFP ≥400 μg/L before operation but still higher than normal level within 3 months after operation are needed to be strictly monitored, and given anti-cancer treatment as early as possible if necessary.