Does transarterial embolization improve survival for recurrent hepatocellular carcinoma after living donor liver transplantation?

Hepatocellular carcinoma (HCC) is the second leading cause of cancer related death in Taiwan. However, HCC recurrence after living donor liver transplantation (LDLT) is an undesirable outcome, and the treatment is controversial due to different recurrent patterns. The aim of this study is to evaluate the efficacy of transarterial embolization (TAE) for HCC recurrence after LDLT. From March 2003 to February 2011, 217 patients received LDLT for HCC under Milan/UCSF criteria in Kaohsiung Chang Gung Memorial Hospital. The clinical profiles, imaging features, histopathologic diagnosis, treatment methods and outcomes of HCC recurrence after LDLT were retrospectively analyzed. TAE was performed with a microcatheter system to protect hepatic artery anastomosis. The endpoint of this study was survival from time of recurrence. Recurrences were found in 15 patients (6.9%) with LDLT for HCC, and were divided into three groups by treatment. Group 1 (n=2) was surgical resection for localized extrahepatic recurrence. Group 2 (n=4) was TAE for intrahepatic recurrence. Group 3 (n=9) was systemic chemotherapy, radiation therapy or conservative treatment for multiple intrahepatic or extrahepatic recurrence. Kaplan-Meier survival estimates showed that the 6- and 12-months survival after recurrence in groupl, 2, 3 was 100%, 75%, 55.5% and 100%, 37.5%, 0% Surgery had significant benefit on survival after recurrence for solitary or localized resectable recurrence. TAE may have an effect in the loco-regional control of intrahepatic recurrence to prolong survival, even where limited extrahepatic metastasis could be controlled by other treatment. Multiple metastasis was usually unresponsive to chemotherapy and/or radiation therapy with shorter survival after recurrence.