Objectives: Hepatocellular carcinoma (HCC) remains a major indication for liver transplantation (LT), but accurate pretransplant risk stratification is critical to improve long-term outcomes. Traditional morphometric criteria such as tumor size and number are limited in predicting recurrence and survival. The HALP (hemoglobin, albumin, lymphocyte, platelet), gamma-glutamyl transpeptidase to platelet ratio (GPR), and FIB-4 indices are emerging systemic inflammatory and nutritional biomarkers that may provide additional prognostic value in HCC patients undergoing LT. Materials and Methods: This retrospective, two-center cohort study included 200 patients who underwent LT for HCC between 2012 and 2023. Preoperative HALP, GPR, and FIB-4 scores were calculated, and their associations with overall survival (OS) and recurrence-free survival (RFS) were assessed using ROC analyses and Cox proportional hazard models. Cut-off values were determined for each biomarker, and survival outcomes were analyzed using Kaplan–Meier methods. Results: A low HALP score (≤0.39) was independently associated with reduced OS but not with RFS. Conversely, low GPR (≤0.45) and FIB-4 (≤3.1) values were significantly associated with both poor OS and higher recurrence risk. Tumor size, number of lesions, and microvascular invasion also independently predicted poor outcomes. Multivariate analysis confirmed HALP, GPR, and FIB-4 as significant preoperative predictors of prognosis in this population. Conclusions: HALP, GPR, and FIB-4 are readily available, cost-effective indices that provide significant prognostic information in HCC patients undergoing LT. Their integration with morphometric criteria may improve pretransplant risk stratification and support individualized clinical decision-making.

Objective: An important characteristic of Hepatocellular carcinoma (HCC) is that it features multicentric recurrences that can recur after curative treatment. Current recommended curative treatments for HCC include liver transplantation (LT), and prognostic evaluation and appropriate treatment selection are crucial in the management of HCC patients. Factors considered tend to include tumor size and number, lobar distribution, multinodularity, α-fetoprotein (AFP) level, degree of tumor differentiation, vascular invasion, and satellite nodules. However, the prognostic value of intrahepatic lymphatic vessel invasion (LVI) has rarely been reported for liver cancers. Methods: From January 2012 to December 2020, a total of 178 HCC patients who underwent liver transplantation consecutively were retrospectively enrolled. Those who underwent liver transplantation were divided into two groups based on the presence or absence of lymphatic vessel invasion. The primary aim was to compare the two groups for overall survival (OS), disease free survival (DFS), and recurrence rates, as well as to evaluate the prognostic effect of LVI after transplantation. Results: Poor tumor characteristics such as high tumor differentiation grade and MVI were significantly higher in the patient group with LI. Tumor recurrence and mortality rates were significantly higher in LI-positive recipients. Conclusions: The lymphatic invasion (LI) group displayed higher rates of recurrence and mortality. The findings emphasize the need to incorporate LI assessment into prognostic evaluations to enhance the management and outcomes of individuals with Hepatocellular carcinoma.

Background/Objectives: Mixed hepatocellular-cholangiocarcinoma and intrahepatic cholangiocarcinoma (CCA) are increasingly reported in patients with cirrhosis. Traditionally, these tumor types have not been considered indications for liver transplantation. We aimed to present our single-center experience for incidental CCA following liver transplantation. Methods: Among the 985 living donor liver transplantations, 261 cases were initially diagnosed as hepatocellular carcinoma. We retrospectively reviewed demographic data, preoperative radiological findings, pathology results, and postoperative outcomes. We classified tumors according to the Goodman classification. Results: Cholangiocarcinoma was identified in the explant pathology of 18 patients. According to the Goodman classification, five patients (27%) had type 1 tumors; eight (44.4%) had type 2 tumors; and five (27.8%) had sole CCA lesions. Tumor recurrence occurred in six patients (33.3%). The mean survival time was 61.6 ± 12 months. The mean disease-free survival was 10.67 ± 5.7 months. Disease-free survival times for Goodman type I, type II, and sole cholangiocarcinoma were 14.00 ± 5.57, 8 ± 5.66, and 6.00 ± 0.00 months, respectively. The 1-year and 5-year survival rates were 88% and 55%, respectively. Four patients died due to CCA; the remaining deaths were due to sepsis, COVID-19, amyotrophic lateral sclerosis, and lung squamous cell carcinoma. Conclusions: The misdiagnosed/incidental cholangiocarcinoma in transplanted patients with cirrhosis is rarely seen with high recurrence rates. Although transplant oncology is gaining prominence, preoperative evaluation and postoperative follow-up remain important.

Objectives: Hepatocellular carcinoma (HCC) is a disease with an increasing incidence. Liver transplantation (LT) represents the sole curative treatment option. Downstaging (DS) therapy represents an option in selecting suitable candidates for transplantation who initially have tumors exceeding the MC. Consequently, patients undergoing DS for MC have demonstrated comparable survival rates to those who initially met the MC. Degradable starch microspheres with transcatheter arterial chemoembolization (DSM-TACE), a type of TACE, have also been recently introduced in clinical practice. Methods: This retrospective study encompassed 200 consecutive adult patients who underwent living-donor LT for HCC and cirrhosis at two different centers from March 2012 to December 2023. We aimed to compare long-term overall survival (OS) and recurrence-free survival (RFS) among patients with HCC who met the DSM-TACE criteria for MC following diagnosis, those initially within MC, and those outside MC following diagnosis. Results: The OS rate in the MC group was statistically comparable to that in the DS and beyond the MC groups. The MC and DS groups exhibited comparable long-term RFS rates. However, the MC and DS groups showed significantly better RFS rates than the beyond the MC group. Microvascular invasion (MVI), tumor size and number, and the beyond the MC group were identified as significant recurrence risk factors, whereas MVI alone was an independent prognostic factor. Conclusions: Our results showed good long-term OS and RFS in HCC patients following LDLT after staging into MC with DSM-TACE. Additionally, we achieved a more acceptable survival rate compared to other treatments in the group that underwent MC staging after DS.