Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2016; 22(9): 2749-2759
Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2749
Impact of non-oncological factors on tumor recurrence after liver transplantation in hepatocellular carcinoma patients
Xiang-Qian Gu, Wei-Ping Zheng, Da-Hong Teng, Ji-San Sun, Hong Zheng
Xiang-Qian Gu, Organ Transplant Center, The First Central Clinical College, Tianjin Medical University, Tianjin 300192, China
Wei-Ping Zheng, Da-Hong Teng, Ji-San Sun, Hong Zheng, Organ Transplant Center, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Zheng H performed the review; Gu XQ wrote the paper; Zheng WP, Teng DH and Sun JS revised the review.
Supported by National High-Tech R and D Program (863 Program; No. 2012AA021003); and the Tianjin Municipal Health Bureau Key Project, No. 13KG103.
Conflict-of-interest statement: The authors declare no conflicts of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong Zheng, PhD, MD, Professor, Organ Transplant Center, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin 300192, China. zhenghongxyx@163.com
Telephone: +86-22-23626112 Fax: +86-22-23626112
Received: October 28, 2015
Peer-review started: October 28, 2015
First decision: November 27, 2015
Revised: December 13, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 7, 2016
Abstract

Hepatocellular carcinoma (HCC) is the most common primary neoplasm of the liver and is one of the leading causes of cancer-related death worldwide. Liver transplantation (LT) has become one of the best curative therapeutic options for patients with HCC, although tumor recurrence after LT is a major and unaddressed cause of mortality. Furthermore, the factors that are associated with recurrence are not fully understood, and most previous studies have focused on the biological properties of HCC, such as the number and size of the HCC nodules, the degree of differentiation, the presence of hepatic vascular invasion, elevated serum levels of alpha-fetoprotein, and the tumor stage outside of the Milan criteria. Thus, little attention has been given to factors that are not directly related to HCC (i.e., “non-oncological factors”), which have emerged as predictors of tumor recurrence. This review was performed to assess the effects of non-oncological factors on tumor recurrence after LT. The identification of these factors may provide new research directions and clinical strategies for the prophylaxis and surveillance of tumor recurrence after LT, which can help reduce recurrence and improve patient survival.

Keywords: Liver transplantation, Immunosuppressive agents, Hepatocellular carcinoma, Recurrence, Living donor, Deceased donor

Core tip: Liver transplantation (LT) has become one of the best curative therapeutic options for patients with hepatocellular carcinoma (HCC). This review discusses the effects of non-oncological factors on tumor recurrence after LT in patients with HCC. These non-oncological factors include the use of immunosuppressive agents, transplant type, hepatitis virus infection, recipient characteristics, and graft-related factors. Our review provides new research ideas and clinical strategies for the prophylaxis and surveillance of post-LT tumor recurrence, and can help the reader improve their management of, and outcomes among, patients with HCC after LT.