Doyle MBM et al. – Orthotopic liver transplantation offers an effective treatment strategy for HCC in the setting of cirrhosis, even in the setting of hepatitis C virus. Hepatocellular carcinoma recurrence is uncommon in properly selected patients and disease–specific long–term survival approaches 90%.

• A 20–year retrospective review of a prospectively collected database was carried out.
• Demographic data and patient survival were calculated.

• There were 1,422 liver transplantations performed between January 1990 and April 2011.
• Of these, 264 had HCC and 157 (59%) were pretreated with transarterial chemoembolization.
• Recipient age was 55.9 (±7.9) years and 208 (79%) of patients were male.
• The underlying disease was hepatitis C virus in 155 (58.7%), hepatitis B virus in 16 (6%), alcohol in 21 (8%), and miscellaneous in the remaining 72 cases.
• The mean number of tumors was 1.8 (±1.7) and the mean largest tumor diameter was 2.3 (±1.3) cm in the explanted liver.
• One, 5, and 10–year patient survival was 88.5%, 69.1%, and 40.5%, respectively; disease–specific survival was 99.1%, 94.4% and 87.9%; and disease–free survival was 86.0%, 64.6%, and 40.1%.
• One, 5, and 10–year graft survival was 87.3%, 68.0%, and 41.8%.
• Nine (3.4%) patients required retransplantation; 75 patients (28.4%) have died, but only 10 of 75 (13.3%) died of recurrent HCC (3.7% of all HCC patients receiving a transplant) and 6 (8%) died of recurrent viral hepatitis.
• An additional 9 recipients developed recurrence (total HCC recurrence, n = 19 [7%]), 4 of whom died of causes other than HCC.
• The remaining 5 are disease–free post–treatment (mean 5.5 years after orthotopic liver transplantation).