Introduction : This study was designed to analyze the impact of venous outflow congestion in the liver graft on hepatocellular carcinoma recurrence with liver transplantation

Methods : Hepatocellular carcinoma patients who underwent living donor liver transplantation in Samsung Medical Center between 2007 and 2018 were reviewed. Based on 2-week post-transplantation computed tomography, volume of the congested parenchyma was calculated. Patients were divided into five groups based on the congestion volume. Recurrence-free survival and overall survival was analyzed using multivariable Cox proportional hazard model including the degree of venous congestion.

Results : A total of 582 patients were included. There were 350 patients (60.1%) with no congestion, while congestion volume less than 100 cm3, between 100 to 200 cm3, between 200 to 300 cm3, and ≥300 cm3 were present in 58 (10.0%), 109 (18.7%), 40 (6.9%) and 25 (4.3%), respectively. Congestion volume (P=0.008) was a significant risk factor recurrence-free survival. Congestion volume of ≥300 cm3 (HR=3.349, CI=1.703-6.587, P<0.001) showed significantly poorer recurrence-free survival compared to patients with no congestion.

Conclusions : Venous outflow congestion in the liver after living donor liver transplantation was related to poor recurrence-free survival of hepatocellular carcinoma.