Hepatocellular carcinoma and living donor liver transplantation; the factors associated with recurrence and survival of patients. A single center experience

Liver transplantation is considered to be the most effective treatment for hepatocellular cancer (HCC) arising in the setting of cirrhosis. However, HCC recurrence remains a concern after liver transplantation. In this study, our goal was to investigate the factors associated with recurrence and survival of the patients after living donor liver transplantation. One hundred and nine patients underwent living donor liver transplantation due to hepatocellular cancer were included in the study. The average age was 55.2 +/- 7.82 (26-72) years and 89% of patients were male. Of the 109 patients, 57 (52.3%) met Milan criteria. The mean tumor size was 36.44 +/- 22.64 (5-140) mm and 55% of tumor had multifocality. Sixteen (14.7%) patients developed tumor recurrence in a mean follow up of 31.4 +/- 26.2 (4-94) months. Tumor size, poor differentiation and hepatitis B recurrence were associated with higher tumor recurrence and lower survival rate. Although tumors outside the Milan criteria were associated with high recurrence, they did not affect survival rate. The survival rate was lower min patients with tumor recurrence. Of the 109 patients, 87 (75.2%) were alive while 27 (24.8%) were deceased. The overall survival rates at first year in patients with recurrence and without recurrence were 54.27 +/- 12.89% and 85.54 +/- 4.36% respectively. In conclusion, tumor recurrence decreases patients survival rate after living donor liver transplantation performed for HCC. In order to predict both tumor recurrence and patient survival, all other tumor characters should be evaluated with the Milan criteria prior to transplantation.