Upfront liver transplantation is the gold-standard in treatment of patients with hepatocellular carcinoma (HCC) and cirrhosis, but a shortage of donor organs negatively impacts on survival outcomes, with significant disease progression during long waiting lists. This systematic review evaluates the safety and efficacy of salvage liver transplantation as treatment for recurrent hepatocellular carcinoma after initial hepatic resection.
Electronic searches of Pubmed, EMBASE and Medline databases identified 130 abstracts, from which 16 eligible studies comprising of 319 patients were selected for review. Studies adopting salvage liver transplantation (SLT) following primary hepatic resection for recurrent HCC, with more than five patients were included. Demographic details, morbidity and mortality indices and survival outcomes were collected from each study and tabulated.
All patients included studies had liver cirrhosis, with the majority being Child-Pugh A (50%) and B (33%). The aetiology of liver disease was Hepatitis B in the majority of patients (84%). Disease recurrence occurred in 27-80% of patients at a median of 21.4 months (range 14.5-34) following initial resection. SLTs were performed on 41% of recurrences and were associated with biliary complications (8%), infection (11%), bleeding (8%) and vascular complications (7%). There were 18 peri-operative deaths (5.6%). The median 1, 3, and 5-year overall and disease-free survival was 89%, 80%, 62% and 86%, 68%, 67% respectively.
Synthesis of available observational studies suggests that SLT following primary hepatic resection is a highly applicable strategy with long-term survival outcomes that are comparable to upfront liver transplantation.