Optimization of Liver Transplantation as a Treatment of Intrahepatic Hepatocellular Carcinoma Recurrence After Partial Liver Resection: Experience of a Single European Series Gonzalo Sapisochin • Itxarone Bilbao • Joaquin Balsells • Cristina Dopazo • Mireia Caralt • Jose Luis La ´zaro • Luis Castells • Helena Allende • Ramo ´n Charco Published online: 22 April 2010 Ó Socie ´te ´ Internationale de Chirurgie 2010 Abstract Background The aim of this study was to ascertain the outcome of liver transplantation (LT) due to hepatocellular carcinoma (HCC) in patients who had undergone previous liver resection (LR) for HCC. Methods A case-control study (1:2) was designed to compare patients who underwent LT due to HCC recur- rence with a previous LR for HCC (study group) with those who underwent LT for primary HCC but without previous LR (control group). Results From January 1990 to December 2007, a total of 303 cirrhotic patients with primary HCC were evaluated for surgery. Primary LT was performed in 191 and LR in 100. When HCC recurrence was diagnosed after LR (69/ 100), 17 of the 69 (25%) patients underwent LT (study group). The median follow-up was 70 months (12.7– 203.0 months). Disease-free survivals at 1, 3, and 5 years in the study group versus the control group were 86%, 68%, 58% vs. 97%, 93%, 89%, respectively (p \ 0.04). The 1-, 3-, and 5-year actuarial patient survivals in the study group versus the control group were 59%, 52%, 52% vs. 85%, 76%, 65%, respectively (p = NS). Patients of the study group were divided into two groups according to the time to recurrence after LR: group 1 was \ 1 year, and group 2 was [ 1 year. Recurrence after LT was 75% in group 1 vs. 15.4% in group 2 (p \ 0.03). The 1-, 3-, and 5-year actuarial patient survivals were 25%, 0%, 0% in group 1 and 69%, 69%, 69% in group 2, p \ 0.02). Conclusions Liver transplantation can be safely per- formed after a previous LR for HCC. Patients with recur- rence during the first year after hepatectomy have a poor prognosis after LT. Introduction Partial liver resection (LR) is a safe, effective treatment for early hepatocellular carcinoma (HCC) in patients with nondecompensated cirrhosis [1, 2]. However, there is a new tumor or recurrence in a high percentage of patients due to various factors, such as liver cirrhosis persistence [3]. Treatment of recurrence includes the use of antineo- plasic drugs, locoregional therapies (radiofrequency, chemoembolization, alcoholization), re-resection, and liver transplantation (LT). The advantage of LT as a treatment for HCC recurrence over other treatments is its efficacy in treating HCC with total hepatectomy, removing underlying cirrhotic tissue and restoring normal liver function [4]. However, owing to organ shortage and other medical rea- sons, LT cannot always be applied; consequently, liver grafts must be optimized and LT performed only in selected cases [5]. Thus, careful selection of patients who may benefit from LT and identifying those whose risk of recurrence is as low as possible must be done preopera- tively. Results regarding LT outcome in patients who G. Sapisochin (&) Á I. Bilbao Á J. Balsells Á C. Dopazo Á M. Caralt Á J. L. La ´zaro Á R. Charco HBP Surgery and Transplantation Department, Hospital Universitario Vall d’Hebron, Universidad Auto ´noma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035 Barcelona, Spain e-mail: sapisochin@me.com L. Castells Hepatology Department, Hospital Universitario Vall d’Hebron, Universidad Auto ´noma de Barcelona, Barcelona, Spain H. Allende Pathology Department, Hospital Universitario Vall d’Hebron, Universidad Auto ´noma de Barcelona, Barcelona, Spain 123 World J Surg (2010) 34:2146–2154 DOI 10.1007/s00268-010-0583-4