Candidate Selection Criteria And Prognostic Factors Of Patients Receiving Salvage Liver Transplantation

ObjectiveAlthough salvage liver transplantation(LT)became widely adopted for the treatment of hepatocellular carcinoma(HCC)recurrence soon after it was proposed,the candidate selection criteria for salvage LT remains controversial.This study aimed to identify the risk factors associated with HCC recurrence and survival after salvage LT.MethodsA total of 74 patients who underwent salvage LT at Shanghai First People's Hospital between October 2001 and February 2013 were included.Patient characteristics and survival curves were studied by univariate and multivariate analysis.Then a risk factors-stratified survival analysis was conducted.ResultsAfter salvage LT,the median follow-up was 37.2 months.There were 29 cases of HCC recurrence and 31 deaths after transplantation.Microvascular invasion(MVI)at liver resection(LR)(OR = 3.71,P = 0.044),time interval ? 12 months to post-LR HCC recurrence(OR = 4.04,P = 0.022),an alpha-fetoprotein level at LT > 200 ng/mL(OR = 6.53,P = 0.033),and having undergone LT outside University of California San Francisco(UCSF)criteria(OR = 6.12,P = 0.016)were independent risk factors for HCC recurrence after salvage LT.Patients with no more than one risk factor had a 5-year recurrence-free survival rate of 71.2% compared to a rate of 15.9% in patients with two or more risk factors.Furthermore,in addition to the UCSF criteria,MVI at LR,time interval to HCC recurrence after LR,and Model for End-Stage Liver Disease score at LT were unfavorable risk factors affecting survival after salvage LT.ConclusionThe priority of salvage LT might be given to patients with no more than one risk factor to avoid post-LT HCC recurrence and a dismal prognosis.Such a policy might improve salvage LT outcomes and facilitate the effective use of limited organ supplies.