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Reduced ischemia time may decrease HCC recurrence after liver transplant

Reduced cold and warm ischemia times could decrease the risk for hepatocellular carcinoma recurrence after liver transplantation, according to data published in Hepatology.

“Our study examines the relationship between ischemia time of the liver graft and the incidence and timing of HCC recurrence after [liver transplant] based on experience from two large transplant centers in the United States,” the researchers wrote.

Researchers analyzed medical records of 271 patients from Mount Sinai Medical Center and 178 patients from Henry Ford Hospital who underwent liver transplant for HCC. Numerous variables, including ischemia times, were analyzed as risk factors for HCC recurrence. Of all the patients, 227 from Mount Sinai Medical Center and 164 from Henry Ford Hospital were included in the final analyses. Median follow-up was 2.9 years.

Overall, recurrence occurred in 15.3% of patients (n = 60), with a median time to recurrence of 0.9 years. HCC recurrence rates were 9% at 1 year and 16.4% at 3 years posttransplant. The researchers used cumulative recurrence curves based on cold ischemia time (CIT) at 2-hour intervals and warm ischemia time (WIT) at 10-minute intervals and determined that a CIT greater than 10 hours and a WIT greater than 50 minutes were associated with increased recurrence for HCC (P = .015, P = .036, respectively).

Multivariate Cox’s regression analysis showed CIT and WIT to be independent risk factors for HCC recurrence, as well as poor differentiation, microvacular invasion, macrovacular invasion, exceeding Milan criteria and alpha-fetoprotein levels greater than 200 ng/mL. In addition, extended CIT and WIT were associated with HCC recurrence within 1 year of transplant (P = .04 for CIT, P = .001 for WIT).

“We have demonstrated that prolongation of ischemia time, both warm and cold, predicts early HCC after [liver transplantation],” the researchers concluded. “Our results suggest that interventions to shorten ischemia times may improve outcomes for patients with HCC who undergo [liver transplantation], especially those with other risk factors for recurrence.” – by Melinda Stevens    

Disclosure: The researchers report no relevant financial disclosures.