Systemic treatment for recurrence of hepatocellular carcinoma after liver transplantation: a case report

Background: Liver transplantation (LT) is considered the optimal treatment approach for patients with cirrhosis progressing to hepatocellular carcinoma (HCC). LT not only allows for complete removal of tumors from the liver but also potentially eliminates cirrhosis. However, recurrence of HCC after LT remains a significant issue, with recurrence rates ranging from 8% to 20%. The median time to recurrence is 14 months, and the median survival after recurrence is 12.2 months. We present the first case of long-term remission following hepatic arterial infusion chemotherapy (HAIC) combined with targeted therapy in a patient with multifocal recurrence and distant metastasis of HCC after LT. Case Description: A 62-year-old male experienced recurrence of HCC after LT, with metastases to the sigmoid colon. Following multidisciplinary discussions, he received HAIC combined with small molecule targeted therapy. The liver tumor lesions and hemorrhagic foci remained stable, even tending to shrink, while tumor marker levels steadily declined. The patient did not experience any serious adverse events during treatment. Unfortunately, the patient developed acute enteritis with dysbiosis following a meal in March 2024, which led to rapid onset of septic shock, ultimately resulting in death. Conclusions: This case suggests that the combination of HAIC and targeted therapy may offer a promising approach for treating recurrent HCC after LT. These findings provide valuable insights for further exploration of treatment strategies for recurrent HCC post-LT and may contribute to advancing clinical research and practice for the benefit of patients.