Extrahepatic Liver Metastasis in the Follow-Up of Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma: Single-Center Experience.

Abstract

Objectives: Hepatocellular carcinoma is a common type of primary liver cancer and a major cause of cancer-related deaths worldwide. Liver transplantation is the choice of treatment for patients with hepatocellular carcinoma within the Milan criteria. Extrahepatic metastasis is a particularly concerning complication of hepatocellular carcinoma recurrence after liver transplant, associated with poor prognosis, and has limited treatment options. We analyzed our results in the incidence and management of extrahepatic metastasis in patients transplanted for hepatocellular carcinoma.

Materials and methods: Between 1999 and 2022, 61 patients underwent liver transplant for hepatocellular carcinoma at our center and were included in the study. At our outpatient department, patients who underwent liver transplant for hepatocellular carcinoma had follow-up and tumor surveillance examinations at specific intervals posttransplant. Examinations included physical examination, ultrasonography of the abdomen and liver, radiographic examination of the chest, serum laboratory tests with α-fetoprotein, and ultrasonography-guided liver biopsy.

Results: The 61 patients followed up for hepatocellular carcinoma were between 22 and 65 years old; 8 (14.1%) were women. Chronic hepatitis B infection was observed in 36 patients (59%). Extrahepatic metastases were observed in 13 patients during follow-up. The mean recurrence time in the 13 patients who developed extrahepatic hepatocellular carcinoma recurrence was 21 months posttransplant. Extrahepatic recurrence included lung, bone, and spleen metastasis in 7 patients, isolated lung metastasis in 3 patients, seeding metastasis in 2 patients, and isolated bone metastasis in 1 patient. Twenty of the 58 patients included in the study received local ablative therapy before transplant.

Conclusions: Hepatocellular carcinoma beyond Milan criteria and microvascular invasion are risk factors for extrahepatic hepatocellular carcinoma recurrence; a multimodal approach is used to manage recurrent disease.