Locoregional therapy and recurrence of hepatocellular carcinoma after liver transplant.

OBJECTIVES Locoregional therapy may decrease the tumor stage and enable liver transplant in patients who have hepatocellular cancer. The purpose of the present study was to assess the relation between locoregional therapy and recurrence of hepatocellular carcinoma after transplant. MATERIALS AND METHODS In 50 patients who had liver transplant for treatment of end-stage liver disease from hepatocellular carcinoma and cirrhosis, outcomes were evaluated for associations with locoregional therapy before transplant and Milan criteria. RESULTS Most patients had locoregional therapy before transplant (31 patients [62%]: transarterial catheter radiofrequency ablation alone, 16 patients; chemoembolization alone, 10 patients; both transarterial catheter radiofrequency ablation and chemoembolization, 5 patients). Follow-up at median 90 months after transplant showed that 9 patients (18%) had recurrence at median 45 months (range, 120 ± 12 mo) (recurrence: locoregional therapy, 5 of 31 patients [16%]; no locoregional therapy, 4 of 19 patients [21%]; not significant). Locoregional therapy was associated with a significantly lower frequency of recurrence in patients who were outside the Milan criteria. CONCLUSIONS In patients who have liver transplant for treatment of hepatocellular carcinoma, preoperative locoregional therapy may decrease recurrence in patients who are outside the Milan criteria.