Evaluation of disease recurrence and incidental findings from an imaging surveillance programme for hepatocellular carcinoma post liver transplant: experience of a UK transplant centre

Background and aims Hepatocellular carcinoma (HCC) is an increasingly common indication for liver transplantation. The purpose of the study was to explore the benefits and drawbacks of surveillance imaging in this patient group and further assess the use of prognostic scoring systems such as the Risk Estimation of Tumour Recurrence After Transplant score (RETREAT). Methods This is a retrospective, single-centre analysis of imaging findings in patients undergoing CT surveillance following liver transplantation for HCC from 2008 to 2014, with subsequent 5-year imaging follow-up and 10-year overall follow-up. Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). Validation of the RETREAT Score was undertaken. Results 135 patients underwent liver transplantation for HCC. At 5 years, 8 patients (6%) were diagnosed with recurrence through surveillance, all of whom died despite some receiving treatment. At 10 years, one further patient died of recurrence. 826 surveillance scans were performed, resulting in 59 incidental findings, mostly benign. RFS post liver transplant and OS were 94% (95% CI 89% to 98%) and 85% (95% CI 79% to 81%), respectively, at 5 years. RETREAT Score validation achieved a C-index for prediction of RFS of 0.88 (95% CI 0.80 to 0.95) and 0.63 (95% CI 0.52 to 0.75) for OS at 5 years. Conclusion The results suggest regular surveillance imaging with curative intent for HCC recurrence post-transplantation may not be of benefit to RFS. The use of prognostic scoring systems such as the RETREAT Score provides valuable prognostic information and may negate the need for regular imaging.