O-2 EVALUATION OF RISK FACTORS AND PROGNOSIS OF HEPATOCELLULAR CARCINOMA RECURRENCE AFTER LIVER TRANSPLANTATION

Introduction and Objectives

Liver transplantation (LT) is the preferred treatment for early-stage HCC. Despite restrictive criteria (Milan), recurrence is high and negatively impacts on LT survival. This study aimed to evaluate risk factors and prognosis of HCC recurrence after LT.

Materials and Methods

Retrospective Brazilian university hospital HCC-transplanted cohort (2002 -2021). Patients transplanted for other causes, with a follow-up < 1 year or with incidental HCC at explant were excluded. Primary outcome was recurrence of HCC. Secondary outcomes were survival and time elapsed until HCC diagnosis. Tumor burden was the sum diameter of all nodules at explant. Data extraction was conducted with Excel, and statistical analysis was performed with SPSS.

Results

186 patients were included (males 123 [66.1%], median age 56 years-old), 153 (82.3%) Milan-in. Locoregional waiting-list therapy was trans arterial chemoembolization (TACE), percutaneous ethanol injection (PEI) or TACE + PEI in 63 (34.2%), 58 (31.5%) and 42 (22.8%) individuals, respectively. Downstaging was achieved in 31 patients (17.8%). Explant analysis with microvascular invasion and Milan-out was detected in 31 (16.9%) and 33 (18%) individuals, respectively. HCC recurrence occurred in 22/183 patients (12%), associated with pre-LT alfa-fetoprotein (AFP) (1.881 [IQR 109-4.510] x 6 [IQR 3-39], p=0.02), Milan-out at explant (59.1% x 11.3%, p<0.0001), microvascular invasion (45.5% x 13.9%, p<0.001), and tumor burden at explant (3.9 cm [IQR 3.2-7] x 3 cm [IQR 2-4], p=0.02). Downstaging had no impact on HCC reappearance. Median recurrence time was 22 months (IQR 10.5-42.5); most frequent sites were lungs (18.2%), liver (13.6%) or multiple (36.4%). Median survival after HCC recurrence was 17 months (IQR 6.5-36).

Conclusions

Tumor burden, Milan-out at explant, microvascular invasion and higher pre-LT AFP levels had a negative impact on HCC recurrence. This can identify patients with higher risk of recurrence by planning screening protocols and making early diagnoses to guide effective treatment.