Analysis of factors affecting recurrence of hepatocellular carcinoma after liver transplantation with a special focus on inflammation markers

Transplantation. 2011 Jun 15;91(11):1279-85. doi: 10.1097/TP.0b013e3182187cf0.


Background: Systemic inflammation markers, such as neutrophil-to-lymphocyte ratio (NLR), have recently emerged as the prognostic factors for recurrence of liver tumors.

Methods: We assessed the ability of NLR and of other variables to predict the outcomes of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). A retrospective analysis was performed in 219 patients with HCC who underwent OLT between 1997 and 2009, with a median follow-up of 40 months.

Results: Overall 3- and 5-year patient survival rates were 76.6% and 70.7%, respectively. Overall 3- and 5-year recurrence-free survival (RFS) rates were 83.8% and 82.1%, respectively. On univariate analysis, the factors affecting overall survival were α-fetoprotein more than 30 ng/mL (P=0.006), NLR more than or equal to 5 (P<0.0001), hepatitis C infection (P=0.043), and presence of microvascular invasion (MVI; P=0.006). Preoperative treatments (P=0.006), α-fetoprotein more than 30 ng/mL (P=0.003), NLR more than or equal to 5 (P<0.0001), exceeding Milan criteria at final histology (P=0.001), poor tumor differentiation (P=0.02), and presence of MVI (P<0.0001) predicted a lower RFS. Cox's proportional hazard model showed that only increased NLR and presence of MVI independently predicted overall survival and RFS.

Conclusions: NLR is an important predictor of outcome after OLT for HCC and should be used to identify OLT candidates at high risk of recurrence.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biomarkers, Tumor
  • C-Reactive Protein / analysis
  • Carcinoma, Hepatocellular / blood
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / surgery*
  • Child
  • Female
  • Humans
  • Inflammation / complications*
  • Liver Neoplasms / blood
  • Liver Neoplasms / mortality
  • Liver Neoplasms / surgery*
  • Liver Transplantation*
  • Lymphocytes / physiology
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / etiology*
  • Neutrophils / physiology
  • Proportional Hazards Models
  • Retrospective Studies
  • Survival Rate
  • alpha-Fetoproteins / analysis


  • Biomarkers, Tumor
  • alpha-Fetoproteins
  • C-Reactive Protein