RETREAT Score Accurately Predicts the Long-Term Risk of HCC Recurrence After Liver Transplantation: A Single-Center Real-Life Validation

<b>Background:</b> Liver transplantation (LT) for Hepatocellular carcinoma (HCC) is still burdened by a significant risk of tumor recurrence. The aim of this study was to apply the Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score for prediction of HCC recurrence and survival. <b>Methods</b>: This retrospective study included all adult patients who consecutively underwent LT for HCC from January 2000 to July 2022 at a single institution. <b>Results</b>: During a median follow-up of 64 months, 56 (19%) out of 298 patients [54%, 36% and 10% with a RETREAT score equal to 0/1 (low), 2/3 (medium) and 4-6 (high), respectively] experienced HCC recurrence after a median of 31 months. The HCC recurrence rates at 1, 5 and 10 years were respectively 4%, 16% and 23%. The 5-year RFS for low-, medium- and high-risk groups were 93%, 78% and 58% (<i>p</i> < 0.001), respectively. In the competitive risk analysis, the medium- and high-risk RETREAT groups had respectively a 2.3 HR (<i>p</i> = 0.017) and 6.4 HR (<i>p</i> < 0.001) of HCC recurrence compared with the low-risk group. Overall, 119 patients died [32 (27%) due to HCC recurrence], and the 5-year survival was 74% (95%, 86% and 61% for low-, medium- and high-risk groups, respectively). In the multivariate analysis, the RETREAT score was associated with the overall survival only for the highest risk class, which yielded a 2.5 HR of death compared with the lowest risk categories (<i>p</i> < 0.001). <b>Conclusions</b>: This study validates the RETREAT score and confirms its ability to predict the risk of HCC recurrence.