Introduction : This study was designed to analyze factors related to the success of salvage liver transplantation in hepatocellular carcinoma (HCC). While liver resection is considered the best locoregional therapy in HCC, there is a high recurrence rate. Salvage liver transplantation may be the best treatment option when feasible.

Methods : Patients who underwent salvage liver transplantation for recurrent HCC after LR from November 1996 to May 2017 were included. Patient demographic data, clinical and pathologic characteristics, operative data, hospital course and follow-up data regarding initial liver resection, locoregional therapy after recurrence and salvage liver transplantation were reviewed. Prognostic factors for recurrence were analyzed using Cox proportional hazard ratio.

Results : Eighty-five of 123 salvage liver transplantation patients were included. Patients who had five or more locoregional therapies prior to salvage liver transplantation (HR=2.20, CI=1.03-4.68, p=0.042), outside Milan criteria at the time of salvage liver transplantation (HR=2.52, CI=1.18-5.37, p=0.017) and an alpha-fetoprotein level above 1,000 ng/mL (HR=5.85, CI=2.18-15.68, p

Conclusions : Continuing five or more locoregional therapies for recurrent HCC after liver resection is related to poor recurrence-free survival after salvage liver transplantation.