Published online Mar 7, 2016. doi: 10.3748/wjg.v22.i9.2749
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
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.
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.