To compare the postoperative survival and tumor recurrence of liver transplant recipients of hepatocellular carcinoma (HCC) conforming to Milan criteria and Hangzhou criteria, and analyze the influencing factors of postoperative survival and tumor recurrence.

A retrospective analysis was made on 119 HCC patients who met Milan criteria and Hangzhou criteria for liver transplantation from February 1, 2014 to December 31, 2018 in the organ transplantation center of the Affiliated Hospital of Qingdao University. There were 79 recipients who met the Milan criteria (Milan criteria group) and 40 recipients who exceeded the Milan criteria but met the Hangzhou criteria (Hangzhou criteria group). All the included recipients received regular follow-up after liver transplantation to collect clinical data such as gender, age and time of operation. The disease-free survival time was determined by the recurrence and metastasis of tumor after transplantation, and the cumulative survival time was determined by the death of the recipient after transplantation. Kaplan-Meier method was used to draw survival curve, log-rank test was used to compare the cumulative survival rate and tumor-free survival rate between groups. Cox proportional hazards model was used to analyze the single factor and multiple factors affecting cumulative survival time and tumor-free survival time. P<0.05 was considered statistically significant.

As of July 31, 2019, the median follow-up time of 119 recipients was 27 months (15-43 months), of which 11 died of tumor recurrence and 27 relapsed and metastasized. The 1-, 3-, and 5-year cumulative survival rates in the Milan criteria group were 98.7%, 90.2% and 90.2%, respectively, and in the Hangzhou criteria group were 97.2%, 73.9% and 73.9%, respectively. No significant difference was found in the 1-, 3-, and 5-year cumulative survival rate between the 2 groups (χ²=0.219, 1.598 and 1.598, P all> 0.05). The 1-, 3-and 5-year cumulative disease-free survival rates in the Milan criteria group were 90.3%, 82.1% and 68.6%, respectively, and in the Hangzhou criteria group were 81.6%, 56.0% and 56.0%, respectively. No significant difference was found in the 1-year and 5-year cumulative disease-free survival rate between the 2 groups (χ²=1.587 and 3.707, P all >0.05), and there was statistically significant difference in the 3-year cumulative disease-free survival rate (χ²=5.543, P<0.05). Multivariate analysis showed that the presence or absence of vascular tumor thrombus before transplantation was an independent risk factor affecting the cumulative survival rate, and the difference was statistically significant (HR=0.159, P<0.05). The presence or absence of vascular tumor thrombus and pathological differentiation type before transplantation were independent risk factors affecting tumor-free survival, with statistically significant differences (HR=0.338 and 0.395, P all<0.05).

HCC liver transplant recipients who meet Hangzhou criteria can obtain satisfactory cumulative survival rate and disease-free survival rate after transplantation. Whether the recipient has vascular tumor thrombus before operation and the degree of pathological differentiation can guide the prevention of tumor recurrence after transplantation.