Safe use of sorafenib in a patient undergoing salvage liver transplantation for recurrent hepatocellular carcinoma after hepatic resection

Sorafenib, a multikinase inhibitor targeting angiogenesis, cell survival, and proliferation in hepatocellular carcinoma (HCC) is a standard therapy for advanced stage disease. However, its utilization as neoadjuvant therapy is under investigation and remains an off label indication. The use of sorafenib in pre-liver transplant setting raises caveats associated with risk of bleeding, wound healing deficiencies, and hepatic decompensation. Herein, we report the case of a patient who after exhibiting HCC relapse post-hepatic resection underwent sorafenib therapy and subsequent transplantation. Sorafenib was well tolerated, and no adverse events were noticed. The use of sorafenib as neoadjuvant therapy in pre-transplant patients is feasible and deserves investigation in large clinical settings.