The adverse impact of early postoperative complications after liver transplantation on long-term prognosis in patients with hepatocellular carcinoma

Purpose: Liver transplantation (LT) is the main treatment for HCC patients, but postoperative complications such as early allograft dysfunction (EAD), acute rejection (AR), and biliary complications can affect the prognosis of patients. However, whether the occurrence of early complications after transplantation will affect the overall survival and tumor recurrence of patients have not been fully studied. We conducted a retrospective clinical study to evaluate the impact of early complications on overall survival and their relationship with HCC recurrence after liver transplantation. Methods: This retrospective study analyzed 378 patients who underwent liver transplantation for HCC between January 2015 and December 2020 at The First Affiliated Hospital, Sun Yat-sen University. The follow-up data of overall survival (OS) and recurrence-free survival (RFS) were collected. Results: Median recurrence-free survival (RFS) was 92.18 months, with RFS rates of 75.9% at 1 year, 60.8% at 3 year, 56.1% at 5 years. 239 (63.2%) patients remained alive following transplantation, and the median overall survival was 100.75 months, with survival rates of 90.5% at 1 year, 71.2% at 3 year, 66.3% at 5years. Multivariate Cox’s regression analysis revealed that postoperative acute rejection (AR) and postoperative early allograft dysfunction (EAD) were independent risk factors for overall survival (OS). AR was the independent risk factors for recurrence-free survival. Conclusions: EAD and AR are independent risk factors for overall survival, and AR is an independent risk factor for recurrence-free survival. Reducing the incidence of EAD, AR and biliary complications after transplantation can effectively improve the overall survival and recurrence-free survival of patients.