Management of Recurrent HCC After Liver Transplantation
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Management of Recurrent HCC After Liver Transplantation Baris Sarici 1
&
Burak Isik 1
&
Sezai Yilmaz 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Liver transplantation is the best treatment option for hepatocellular carcinoma (HCC). Although centers use strict selection criteria, there is a risk of recurrence, reaching up to 20% which are mostly observed within two years following the procedure. The survival after the recurrence is poor and it has been reported to be between 7-16 months. This poor prognosis is due to the systemic course of the recurrence even its presentation is local initially. Results The clinical management and treatment algorithm of recurrence is challenging and there is no guideline regarding the situation. Staging of the disease and multi-disciplinary approach are important. The decision for choice of treatment is given depending on the localization and spread of the recurrence. Adjusting and switching the immunosuppressive therapy should be the first attempt. When the recurrence is limited or confined to resectable regions, surgery should be the choice of treatment. Multiple recurrence sites such as adrenal glands, lung, lymph nodes are not contraindication for curative surgery. Resection of the graft for intrahepatic recurrence is the most beneficial procedure for survival. If resection is not possible due to advanced hepatic disease, loco-regional therapies such as TACE, RF, microwave ablation should be considered. SBRT may be an alternative both for hepatic and extra-hepatic recurrence. In case of systemic disease, sorafenib should be the drug choice. Keywords Hepatocellular carcinoma . Liver transplantation . Locoregional therapies . Recurrence
Introduction Liver transplantation (LT) is the best treatment option for hepatocellular carcinoma (HCC) in suitable patients as the underlying disease is also eliminated. Since the introduction of Milan criteria, survival after LT for HCC is comparable with other indications of transplantation [1]. Although centers use strict selection criteria, there is a risk of recurrence, reaching up to 25% of the cases [2, 3]. Approximately 75% of the recurrences occur within 2 years of the transplantation, and early recurrence is with poor survival with 7–16 months [4–9]. Recurrence after transplantation appears when a distant metastasis was not detected before transplantation or HCC cells in the circulation grow in any organ [10].
* Baris Sarici [email protected] 1
Departmant of Surgery, Liver Transplantation Institute, Inonu University, 44315 Malatya, Turkey
Since the first report regarding HCC recurrence treatment after LT in 1995, there is still no consensus or an established guideline for the management of this situation [11].
Maintenance of Immunosuppression The first step should be the revision of immunosuppressant protocol. Immunosuppression should be lowered to the possible dose which protects against rejection, and immonosuppressive regimen should be reconsidered [12].
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