Short- and Long-Term Outcomes After Salvage Liver Transplantation Versus Primary Liver Transplantation for Hepatocellular Carcinoma: A Meta-analysis

Background. Salvage liver transplantation (SLT) has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after primary liver resection. However, the survival outcomes and recurrence rates of SLT versus primary liver transplantation (PLT) for HCC remain controversial. Here we sought to compare the short- and long-term outcomes after SLT and PLT, by conducting a quantitative meta-analysis. Methods. A systematic literature research was performed to identify comparative studies on SLT and PLT. Perioperative and long-term outcomes constituted the end points. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (95% CI) were calculated using either fixed-effects or random-effects model. Results. A total of 1508 patients from 14 studies were included. Although SLT spent more operative time than SLT (WMD: 28.69min; 95% CI: 11.30-46.08; P =.001), the two groups had no significant differences in the postoperative morbidity, perioperative mortality and length of postoperative hospital stay. No significant difference was observed between two groups for long-term outcomes of overall survival. Although 5-year disease-free survival was inferior in SLT, 1- and 3-year disease-free survivals were similar. After stratifying the various studies by Milan criteria, no difference was seen in 1-, 3-, and 5-year survival rates between two groups who meet Milan criteria at the time of liver transplantation. Conclusions. The current study demonstrates SLT for recurrent HCC is feasible and it can achieve the same short- and Jong-term outcomes as PLT. Therefore, SLT may be accepted as the treatment of choice for patients with recurrent HCC.