Surveillance for HCC after liver transplantation: Increased monitoring may yield aggressive treatment options and improved postrecurrence survival

David D. Lee, Gonzalo Sapisochin, Neil Mehta, Andre Gorgen, Kaitlyn R. Musto, Hana Hajda, Francis Y. Yao, David O. Hodge, Rickey E. Carter, Denise M. Harnois

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background. Currently, no surveillance guidelines for hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) exist. In this retrospective, multicenter study, we have investigated the role of surveillance imaging on postrecurrence outcomes. Methods. Patients with recurrent HCC after LT from 2002 to 2016 were reviewed from 3 transplant centers (University of California San Francisco, Mayo Clinic Florida, and University of Toronto). For this study, we proposed the term cumulative exposure to surveillance (CETS) as a way to define the cumulative sum of all the protected intervals that each surveillance test provides. In our analysis, CETS has been treated as a continuous variable in months. Results. Two hundred twenty-three patients from 3 centers had recurrent HCC post-LT. The median follow-up was 31.3 months, and median time to recurrence was 13.3 months. Increasing CETS was associated with improved postrecurrence survival (hazard ratio, 0.94; P < 0.01) as was treatment of recurrence with resection or ablation (hazard ratio, 0.31; P < 0.001). An receiver operating characteristic curve (area under the curve, 0.64) for CETS covariate showed that 252 days of coverage (or 3 surveillance scans) within the first 24 months provided the highest probability for aggressive postrecurrence treatment. Conclusions. In this review of 223 patients with post-LT HCC recurrence, we found that increasing CETS does lead to improved postrecurrence survival as well as a higher probability for aggressive recurrence treatment. We found that 252 days of monitoring (ie, 3 surveillance scans) in the first 24 months was associated with the ability to offer potentially curative treatment.

Original languageEnglish (US)
Pages (from-to)2105-2112
Number of pages8
JournalTransplantation
DOIs
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'Surveillance for HCC after liver transplantation: Increased monitoring may yield aggressive treatment options and improved postrecurrence survival'. Together they form a unique fingerprint.

Cite this