الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Orthotopic liver transplantation became the most effective treatment modality for patients with unresectable HCC that fulfills the transplantation criteria as it since it treats the tumor as well as the underlying liver disease. Despite implementation of Milan criteria has improved survival, however, HCC recurrence still occurred within a range of 10-20%. Most of the recurrences were found to occur among patients with high-risk HCC features such as tumor burden exceeding Milan criteria, high preoperative AFP, poor tumor differentiation, vascular invasion.
Sorafenib is an oral multitargeting tyrosine kinase inhibitor which has antiproliferative, antiangiogenic, and antineoplastic effects which demonstrated favorable preventive outcomes in some studies that assessed its effect on HCC recurrence.
The aim of the present study was to determine the efficacy and overall safety profile of prolonged administration of oral sorafenib to prevent HCC recurrence following liver transplantation among recipients having HCC with high-recurrence risk criteria.
One hundred-eighty transplants (29.2%) were performed for hepatocellular carcinoma which represented our study cohort with a mean follow-up of 5.2 years. They were 136 males and 44 females. The median age was 62 years. Viral hepatitis was the most common cause for HCC (78.9%, n=142), followed by alcoholic cirrhosis (8.3%, n=15) and nonalcoholic steatohepatitis (6.7%, n=12). The median listing MELD was 33 (IQR=31–36). Nine patients required simultaneous liver-kidney transplantation for having concomitant ESRD. Eighty-two patients (45.6%) presented with single HCC lesion based on preoperative imaging. One hundred-seventy patients (94.4%) had their tumor burden within Milan criteria based on preoperative radiologic assessment. The median highest AFP prior to transplantation was 78 ng/mL (IQR=28–200).
TACE was the most common locoregional therapy used for bridging (42.2%, n=76), as well as downstaging (8 out of 10 downstaged patients).
Overall survival (OS) at 1, 3, and 5 years post-LT were 91.1%, 88.9%, 87.8%. Recurrence-free survival was 89.8%, 85.1%. and 84.5%, respectively. Among 22 patients who died across the study period, HCC recurrence was the most common cause of mortality (n=8), followed by sepsis and multisystem organ failure (n=7), sudden cardiac arrest (n=6), and de novo metastatic angiosarcoma (n=1).