Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm

Core Tip

Core tip: We propose a multi-disciplinary management algorithm for recurrent hepatocellular carcinoma after liver transplantation. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor can be considered. Staging is performed to differentiate between disseminated recurrence and oligo-recurrence. In patients with disseminated recurrence, sorafenib may confer survival benefits but is associated with significant toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic and extra-hepatic oligo-recurrences can be managed with surgical resection, ablative therapy or regional treatments depending on the disease status.