Salvage Living Donor Liver Transplantation (SLDLT) as a Treatment Modality for Recurrent Hepatocellular Carcinoma (HCC)

Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer all over the world. Salvage living
donor liver transplantation (SLDLT) has been proposed for patients who developed HCC recurrence after primary
resection or liver deterioration in patients undergoing liver resection (LR).
Aim of the work: The aim of this study is to compare and evaluate the patient survival and cancer recurrence
rates between patients who underwent (SLDLT) and (PLT) in our centers between 2014 and 2018.
Patients and methods: A retrospective study was conducted on total of 110 HCC patients who underwent
LDLT for HCC from January 2014 till January 2018 by the same surgical team at 3 centers (Ain Shams University
Specialized Hospital, Wadi-ElNile Hospital and Egypt Air Hospital). Patients were divided into two groups. Group A
included primary LDLT for 95 cases which were within Milan criteria and group B for SLDLT was performed in 15
cases.
Results: Among the 110 HCC patients, 95 (86.4%) underwent PLT, and 15 (13.6%) underwent SLT for HCC
recurrence after the primary resection. The operative time was significantly more (P value=0.001) in the SLT
recipients group, as the median operative time was (10) hours while it was (8) hours in the PLT recipients group. For
all post-operative complications, no statistical significant difference was found between the PLT and SLT recipients.
Similar rates were observed as regard the overall survival between the SLT and PLT recipients. However, the 1
year, 3 year and 5 year disease-free survival rates were 94.5%, 93.0%, and 92.1% in PLT recipients, compared to
recurrence that occurred in 1 patient after 9 months (6.7 %) in SLT recipients which was not significantly different
statistically.
Conclusion: Our study shows that SLT is a safe and technically feasible procedure for patients who developed HCC
recurrence following primary liver resection. Also, the survival rates were similar to PLT.