Tumor surveillance-what can and should be done? Screening for recurrence of hepatocellular carcinoma after liver transplantation
1. The overall rate of recurrence of hepatocellular carcinoma (HCC) after liver transplantation ranged from 11 to 18% in three of the largest series, with some differences in pre-transplant selection criteria. 2. Patients whose explant pathology is within the currently accepted criteria for transplantation have a low rate of recurrence (8%). Patients whose pathology is outside of the criteria have a 50% chance of recurrence, suggesting that post-operative pathology should be used to stratify screening. 3. About 10% of patients with recurrence appear to be long-term survivors after surgical therapy for the recurrence. 4. Screening all patients for HCC recurrence after transplantation is probably not cost effective and selecting patients with high risk explant pathology would be more cost effective. 5. Surprisingly, there is a dearth of information in the literature that would suggest rational screening protocols. I could not find a single article that examined protocols for screening for recurrence after transplantation. What follows is my interpretation of the effectiveness of screening after transplantation for HCC.