Copyright ©The Author(s) 2019.
World J Hepatol. Mar 27, 2019; 11(3): 261-272
Published online Mar 27, 2019. doi: 10.4254/wjh.v11.i3.261
Table 1 Factors possibly associated with the recurrence of hepatocellular carcinoma after liver transplantation
Related to the tumorRelated to the patientRelated to the treatment
Tumor stagingObesityPretransplantation:
Vascular invasionViral etiologyPercutaneous tumor biopsy
HCV treatment
Differentiation’s gradeWaiting time
NAFLDBridging therapy
Alpha-fetoproteinDonor’s age
Neutrophil-lymphocyte ratioIschemia time
Surgical technique
Enhanced uptake in PET scanImmunosuppression
Adjuvant sorafenib
MRI findings with gadoxetic acid
Response to LRT
Table 2 RETREAT score to estimate the risk of tumor recurrence after liver transplantation in patients with tumors within the Milan criteria and proposed protocol for tumor recurrence screening[74]
Risk factorScore
Alpha-fetoprotein level before LT
0–20 ng/mL0
21–99 ng/mL1
0–999 ng/mL2
> 1000 ng/mL3
Microvascular invasion2
Sum of the diameter of the largest viable tumor and the number of viable nodules
≥ 103
RETREAT ScoreScreening Protocol
0 pointsScreening not needed
1-3 pointsScreening every 6/6 mo for 2 yr
4 pointsScreening every 6/6 mo for 5 yr
≥5 pointsScreening every 3-4 mo for 2 yr Exams every 6 mo between the 2nd and 5th year
Table 3 Prognostic score for the prediction of survival after hepatocellular carcinoma recurrence after liver transplantation[77]
Poor prognostic variables
Early tumor recurrence (during the first year after transplantation)
AFP ≥ 100 ng/mL at the time of the TR
Tumor not susceptible to curative therapy
ScorePrognostic score1st year survival after TR
No variableGood prognosis73%
1 or 2 variablesModerate prognosis55%
3 variablesPoor prognosis17%