Rare Recurrence of Hepatocellular Carcinoma Greater than 6 Years after Living Donor Liver Transplant

Living donor liver transplant (LDLT) for patients within Milan criteria (one lesion smaller than 5 cm; up to 3 lesions smaller than 3 cm, no extrahepatic manifestations, no evidence of gross vascular invasion) has been an evolving modality for the treatment of hepatocellular carcinoma (HCC) in the last decade [1,2,3]. Orthotopic liver transplant (OLT) was once considered an experimental approach in the pediatric population has now gained its popularity in the management of liver cancer in adults and has led to shortening of time on the liver transplant (LT) waitlist. Observational studies have shown comparable outcomes between LDLT and deceased donor liver transplant (DDLT) with regards to overall survival and disease-free survival rates. Unfortunately, recurrence post LDLT as with DDLT remains an ongoing issue and rates up to 10% have been reported at 4 years post-transplant [4].