Hepatic artery chemoembolization for hepatocellular carcinoma recurrence confined to the transplanted liver

Background: Careful hepatocellular carcinoma (HCC) case selection permits orthotopic liver transplantation with the expectation of around 70% plus 5-year survival. However, many patients have tumor recurrences and there is little literature guidance in the management of these patients. Aims: A retrospective examination of patients transplanted with HCC who subsequently developed liver recurrence. Methods: A case cohort series of patients was prospectively followed who had liver-only multifocal tumor recurrence of HCC after liver transplant and were then treated with chemoembolization. Results: All 6 patients had recurrent HCC. 2 had no response, 1 had stable disease, 2 had partial response (PR) and 1 had complete disappearance (CR) of disease. Their survival (in months) was: 13 (no response), 18 (no response), 12 (stable disease), 19 (PR), 30 (PR) and 50 (CR). There were no liver toxicities. Conclusions: Chemoembolization for tumor recurrence in the transplanted liver is as safe as or safer than in the pre-transplant liver, due to the absence of cirrhosis. In this series, there were 3 of 6 responses with some long survivors.