Surveillance for HCC after Liver Transplantation: Increased monitoring may yield aggressive treatment options and improved postrecurrence survival. Journal Article

Local Library Link: Find It @ Loyola

Authors: Lee, DD; Sapisochin, G; Mehta, N; Gorgen, A; Musto, KR; Hajda, H; Yao, FY; Hodge, DO; Carter, RE; Harnois, DM
Article Title: Surveillance for HCC after Liver Transplantation: Increased monitoring may yield aggressive treatment options and improved postrecurrence survival.
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 2002-2016 were reviewed from 3 transplant centers (UCSF, 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: 223 patients from 3 centers had recurrent HCC post-LT. The median followup was 31.3 months and median time to recurrence was 13.3 months. Increasing CETS was associated with improved postrecurrence survival (HR 0.94, p 0.01) as was treatment of recurrence with resection or ablation (HR 0.31, p0.001). An ROC curve (AUC=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. CONCLUSION: 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 (i.e. 3 surveillance scans) in the first 24 months was associated with the ability to offer potentially curative treatment.
Journal Title: Transplantation
ISSN: 1534-6080; 0041-1337
Publisher: Unknown  
Date Published: 2020