Harm and benefits of salvage transplantation for hepatocellular carcinoma: an updated meta-analysis

Objective The aim of this work was to compare salvage liver transplantation (SLT) and primary liver transplantation (PLT) in terms of the harm and benefits. Methods The authors searched Pubmed, Embase, and the Cochrane Library from their dates of establishment to December 2015. Based on selection and exclusion criteria, 2 researchers screened the literature independently. The meta-analysis was performed with the use of the Review Manager software. Meta-analysis of the pooled standard mean difference (SMD) and odds ratio (OR) with 95% confidence interval (CI) were calculated based on either a fixed-effects or a random-effects model. In addition, risk of bias was assessed with the use of the Newcastle-Ottawa scale. Results Sixteen studies were selected, involving almost 8,707 patients. According to the pooled estimates, compared with PLT, SLT was associated with a longer operative time (SMD, 0.28; 95% CI, 0.11–0.46;), higher intraoperative blood loss (SMD, 0.41; 95% CI, 0.08–0.75;), more postoperative bleeding (OR, 1.95; 95% CI, 1.10–3.45), an increased risk of recurrence (OR, 2.08; 95% CI, 1.24–3.50), and poorer 3-year (OR, 0.86; 95% CI, 0.76–0.98) and 5-year (OR, 0.86; 95% CI, 0.76–0.98) overall survival rates. However, no difference was detected between case and control groups in either rates of postoperative complications or such aspects as perioperative mortality, length of intensive care unit stay, length of hospital stay, and 1-year overall survival rate. Conclusions The 3-year and 5-year overall survival rates were inferior in SLT, which shows that PLT is a better treatment strategy for transplantable hepatocellular carcinoma (HCC). However, considering the severe organ limitation and the feasibility and safety of SLT, it provides a better option for patients with HCC recurrence after curative resection