Disadvantage of Viable Portal Vein Tumor Thrombosis in Liver Transplantation for Advanced Hepatocellular Carcinoma.

Simple Summary: Liver transplantation (LT) is an optimal treatment option for hepatocellular carcinoma (HCC) associated with cirrhosis. Additionally, the transplantation community is eager to expand the criteria for transplantation to accommodate more patients with HCC. Despite numerous efforts to broaden LT eligibility, HCC with portal vein tumor thrombosis (PVTT) remains a contraindication due to the associated risk of poor prognosis after transplantation. However, there have been arguments addressing the dilemma of LT in cases of HCC with PVTT. This study aimed to analyze the outcomes of LT in patients with HCC and portal vein thrombosis, specifically evaluating the impact of PVTT on long-term outcomes. The results indicate that the presence of residual viable tumor within the portal vein thrombus may lead to poor outcomes following LT. Therefore, patients with HCC and PVTT could still be considered for LT after appropriate downstaging treatment. However, caution should be exercised regarding the potential for residual viable PVTT, which may result in unsatisfactory outcomes after LT. Background: Liver transplantation (LT) is a promising treatment option for patients with hepatocellular carcinoma (HCC) comorbid with cirrhosis. However, HCC with portal vein tumor thrombosis (PVTT) remains an absolute contraindication for LT. This study aimed to analyze the outcomes of LT in patients with HCC plus portal vein thrombosis and further evaluate the impact of PVTT on the long-term outcomes of patients. Methods: Among the 501 patients who underwent LT for HCC between January 2000 and March 2023, 29 (5.8%) patients with HCC who had portal vein thrombosis were further analyzed. Of these 29 patients with portal vein thrombosis, 12 (41.4%) were preoperatively diagnosed with PVTT and underwent LT after receiving downstaging therapy. The remaining 17 (58.6%) patients were PVTT-free prior to LT. Results: Overall, the recurrence-free survival rates at 1, 3, and 5 years were 96.3%, 74.2%, and 74.2%, respectively, while the 1-, 3-, and 5-year overall survival rates were 82.4%, 74.2%, and 70.1%, respectively. However, patients with viable PVTT had significantly worse outcomes than those without viable PVTT (p = 0.030). The 5-year recurrence-free and overall survival rates for patients with viable PVTT were 57.5% and 57.0%, respectively. Conclusions: LT may still be a promising option for patients with HCC and PVTT after appropriate downstaging. However, caution should be adopted, as remnant viable PVTT might lead to unsatisfactory outcomes after transplantation. [ABSTRACT FROM AUTHOR]