Follow-up Imaging After Liver Transplantation Should Take Into Consideration Primary Hepatocellular Carcinoma Characteristics

Background. Tumor recurrence occurs in almost 10% after liver transplantation (LT) for early stage hepatocellular carcinoma (HCC). Evidence-based recommendation regarding these techniques and their schedule remains unclear. The aim was to analyze the imaging characteristics of HCC recurrence after LT according to the initial primary tumor characteristics to provide relevant evidence regarding their role. Methods. Among 336 cirrhotic patients undergoing LT between 2000 and 2011, 25 (7.4%) experienced HCC recurrence. Their pre-LT characteristics, long-term outcome and imaging characteristics of recurrences were retrospectively analyzed. Results. All patients were men and median age at the time of recurrence was 54 (41-64) years. Before LT, 13 (52%) patients had HCC outside the Milan criteria. Median time to HCC recurrence was 13.8 months (1-75) after LT and 8 patients (32%) experienced recurrence longer than 24 months after LT. The most frequently involved organs were the lungs (n = 13, 52%) and the bones (n = 9, 36%). Recurrent HCC involved more than 1 organ in 11 patients (44%). Recurrences were limited to the liver in 1 patient (4%), exclusively extrahepatic in 18 patients (72%), and were both intra and extrahepatic in 6 patients (24%). Delay of recurrence was shorter in the presence of microvascular invasion (17 vs 28 months), but this was not significant (P = 0.208). Poorly differentiated tumors showed a trend toward decreased recurrence-free survival (8 vs 28 months, P = 0.075). Conclusions. Both pattern and delay of HCC recurrence support performing regular whole-body imaging initially every 6 to 12 months and continuing beyond 2 years after LT for HCC, especially in patients with pejorative pathological features of the primary tumor that could influence HCC recurrence pattern.