Comparative outcomes of liver transplantation and liver resection in hepatitis B and C patients with hepatocellular carcinoma

Background: Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections leading to hepatocellular carcinoma (HCC) pose significant challenges in healthcare. Liver Transplantation (LT) and Liver Resection (LR) are critical treatments for HCC, yet there's a lack of comprehensive comparative studies on their efficacy, especially in hepatitis patients. This meta-analysis aims to compare LT and LR in HCC patients, with a HBV or HCV infection. Materials and methods: A thorough literature review was conducted using Medline and PubMed, adhering to PRISMA guidelines. Studies were selected and analyzed using RevMan software. The primary endpoint was overall survival (OS), with recurrence-free survival (RFS) as a secondary endpoint. A total of 64 studies involving 19,734 patients were included. Results: The analysis revealed that LT generally offers better long-term survival compared to LR, particularly evident at the three and five-year follow-up marks. Surprisingly, in HCV patients, LR showed a temporary advantage in OS at the three-year mark, but this was not sustained. LT consistently showed better RFS in HCV patients across all follow-up periods. Discussion: This meta-analysis highlights the complexity of treating HCC in hepatitis patients and suggests an advantage of LT over LR, especially in HCV-infected individuals. However, the retrospective nature of the studies and high heterogeneity limits the strength of conclusions. Further high-quality, prospective research is needed. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).