Maxime Ronot MD, Presenter: Nothing to Disclose

Marco Dioguardi Burgio MD, Abstract Co-Author: Nothing to Disclose

David Fuks, Abstract Co-Author: Nothing to Disclose

Federica Dondero, Abstract Co-Author: Nothing to Disclose

Francois Cauchy, Abstract Co-Author: Nothing to Disclose

Valerie Paradis MD, Abstract Co-Author: Nothing to Disclose

Francois Durand, Abstract Co-Author: Nothing to Disclose

Jacques Belghiti MD, Abstract Co-Author: Nothing to Disclose

Valerie Vilgrain MD, Abstract Co-Author: Nothing to Disclose

To analyze the imaging characteristics of hepatocellular carcinoma (HCC) recurrence following liver transplantation (LT) in order to optimize follow-up imaging in diagnosing recurrence. 

Between 2000 and 2011, all HCC patients who underwent LT were searched and only patients who had tumor recurrence were included. Pre-LT characteristics, and long-term outcome were retrospectively analyzed. Characteristics of recurrent HCC were analyzed at diagnosis on post-LT examinations as follows: 1/ site of recurrence defined as hepatic, extra-hepatic, or both, 2/ size of the largest lesions (mm on axial sections), and 3/ the time to recurrence, defined as the time between LT and diagnosis of recurrence. The imaging modality of recurrence detection (ultrasound (US), CT or MRI) was noted. 

Among 336 cirrhotic patients undergoing LT, 25 (7.4%) had HCC recurrence. All patients were males (median age 54 (41-64) years). Before LT, 13 (52%) patients had lesions outside the Milan criteria. Median time to HCC recurrence was 13.8 (1-75) months following LT and 8 (32%) patients experienced recurrence beyond 24 months after LT. Recurrences were detected using routine US follow-up in only 7 (28%) patients, and CT or MRI imaging in 18 (72%) of the patients including 5 (20%) who had marked increase of serum alpha-fetoprotein. The most frequently involved organs were the lungs in 13 (52%) patients, and the bones in 9 (36%) patients. Recurrent HCC involved more than one organ in 11 (44%) patients. Recurrences were limited to the liver in one (4%) patient, were exclusively extrahepatic in 18 (72%) patients and were both intrahepatic and extrahepatic in six (24%) patients. 1, 3- and 5-y OS of patients with HCC recurrence after LT were 84%, 39%, and 28%, respectively.

Routine US examination alone fails to detect most HCC recurrences. Because HCC recurrence is mainly extra-hepatic, may be delayed, and is rarely seen using US examination, we suggest performing regular whole-body imaging (CT or MRI) during follow-up visits 2 years or more after LT

Imaging follow-up of patients undergoing LT for HCC should include regular whole-body imaging during follow-up visits 2 years or more after LT.

Ronot, M, Dioguardi Burgio, M, Fuks, D, Dondero, F, Cauchy, F, Paradis, V, Durand, F, Belghiti, J, Vilgrain, V, Pattern of HCC Recurrence after Liver Transplantation: Time to Modify the Current Follow-up Imaging Modalities?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003707.html