Photo Credit: Panuwat Dangsungnoen

Compared with caval sparing (CS), the total caval replacement (TCR) approach for recipient hepatectomy in liver transplant may be protective against post-transplant tumor recurrence, researchers reported in Liver Transplantation. The multicenter retrospective study assessed the impact of recipient hepatectomy (CS vs TCR) on risk for post-transplant HCC recurrence. Exclusion criteria included living-donor liver transplant and prior liver resection for HCC. In the cohort of 2,420 patients, CS and TCR approaches were used in 1,452 (60%) and 968 (40%) cases, respectively. The researchers performed group adjustment with inverse probability weighting for high-volume center, recipient age, alcohol abuse, viral hepatitis, Child-Pugh class C, Model for End-Stage Liver Disease score, cold ischemia time, clinical HCC stage within Milan criteria, pre-transplant downstaging/bridging therapies, pre-LT alpha-fetoprotein serum levels, number and size of tumor nodules, microvascular invasion, and complete necrosis of all tumor nodules (matched cohort; TCR, n=938; CS, n=935). In a multivariate cause-specific hazard model, higher recurrence risk (HR: 1.536, P=0.007) was associated with CS.