Resection for extrahepatic recurrence after liver transplantation for hepatocellular carcinoma

Introduction: A few studies have been reported on extrahepatic metastasis after liver transplantation (LT) for hepatocellular carcinoma (HCC). We investigated clinical outcomes of patients with extrahepatic recurrence (EHR) of HCC after LT. Method: We retrospectively reviewed 395 patients who underwent LT for HCC from March 2005 to December 2015. 92 patients (23.2%) were diagnosed with a HCC recurrence. Clinicopathological data of patients with EHR were analyzed for overall survival rate and prognostic factors. Results: After a median follow-up of 25.3 months, 66 patients (71.7%) initially presented with EHR. The sites of EHR were lung (n=32), bone (n=12), lymph nodes (n=7), adrenal gland (n=1), and others (n=14). Median time to EHR was 7.4 months. Forty-five patients (68.1%) underwent curative resection for EHR. The 1, 3, 5-year overall survival rate of patients with EHR were 81.6%, 46.4%, and 33.1%. Resection for EHR was only a significant factor associated with multivariate analysis (HR 0.233, 95% CI 0.114-0.474, p = 0.0001). The 1, 3, 5-year OS of patients with resection and without resection for EHR were 91.1%, 64.0%, 41.8% and 60.7%, 0%, 0%, respectively (p < 0.05). In subgroup analysis according to Milan criteria, overall survival rate of patients who underwent resection for EHR were better than those of patients without resection for EHR in both within and beyond Milan group. Conclusions: Resection of EHR may be a beneficial treatment to increase survival rate after LT for HCC in selected patients.