Salvage liver transplantation versus curative treatment for patients with recurrent hepatocellular carcinoma: A systematic review and meta-analysis

Background Salvage liver transplantation (SLT) is an effective treatment option for recurrent hepatocellular carcinoma (rHCC) following primary curative treatment (CUR). However, its efficacy remains controversial compared to that of CURs, including repeat liver resection (RLR) and local ablation. This meta-analysis compared the efficacy and safety of these procedures. Methods A systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases for studies investigating SLT and CUR was performed. Outcome data, including overall and disease-free survival, tumor response, and operative and postoperative outcomes, were independently extracted and analyzed by two authors using a standardized protocol. Results Fifteen cohort studies comprising 508 and 2050 patients with rHCC, who underwent SLT or CUR, respectively, were included. SLT achieved significantly longer overall survival than both CUR (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.45-0.68; I2 = 34.6%, p = 0.105) and RLR (HR: 0.64, 95% CI: 0.49-0.84; I2 = 0.0%, p = 0.639). Similar significantly better survival benefits were observed compared with CUR (HR: 0.30, 95% CI: 0.20-0.45; I2 = 51.1%, p = 0.038) or RLR (HR: 0.31, 95% CI: 0.18-0.56; I2 = 65.7%, p = 0.005) regarding disease-free survival. However, SLT resulted in a longer operative duration and hospital stay, larger amount of blood loss, higher rate of transfusion and postoperative morbidity, and slightly higher postoperative mortality than CUR. Conclusion SLT was associated with better long-term survival than CUR or RLR in patients with rHCC after primary curative treatment.