Hepatocellular Carcinoma Recurrence and Mortality Rate Post Liver Transplantation: Meta-Analysis and Systematic Review of Real-World Evidence

Abstract

Background: liver transplantation (LT) is the best curative option for eligible patients with hepatocellular carcinoma (HCC), however recurrence remains a major concern. This meta-analysis aimed to investigate the prevalence and risk factors of HCC recurrence.

Methods: studies were selected using PubMed, Epistemonikas, and Google Scholar databases published from inception to 15 May 2022 and a meta-analysis of the proportions was conducted. Observational studies reporting the prevalence of recurrent HCC after an LT were included, with the analysis being stratified by an adherence to the Milan criteria (MC), geographical region, AFP levels, and donor type.

Results: out of 4081 articles, 125 were included in the study. The prevalence of recurrent HCC was 17% (CI: 15-19). Patients beyond the MC were more likely to recur than patients within the MC. Asian populations had the greatest prevalence of HCC recurrence (21%; CI: 18-24), whereas North American populations had the lowest recurrence (10%; CI: 7-12). The mortality rate after HCC recurrence was 9%; CI: 8-11. North American populations had the greatest prevalence of mortality with 11% (CI: 5-17).

Conclusions: the recurrence, overall survival, and mortality rates among patients with HCC post-LT remains high, with substantial differences between regions.

Keywords: AFP; HCC recurrence; Milan criteria; liver transplant.

Figure 1

PRISMA diagram of the literature selection in this systematic literature review and meta-analysis.

Figure 2

Pooled prevalence of HCC recurrence of all included studies.

Figure 3

Pooled prevalence stratified by Milan criteria in patients with HCC recurrence after LT.

Figure 4

(A) Funnel plot of prevalence off recurrence rate in patients with HCC who underwent LT treatment. (B) Funnel plot of prevalence of mortality due to recurrence in patients with HCC who underwent LT treatment.