Recurrent hepatocellular carcinoma after liver transplantation: Spectrum of CT findings and recurrence patterns

PURPOSE: To correlate computed tomographic (CT) and serum tumor marker (α-fetoprotein [AFP] and desgamma-carboxy-prothrombin [DGCP]) findings in recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT). MATERIALS AND METHODS: At retrospective review of the cases in 124 patients, CT findings were recorded by consensus of at least two nonblinded observers and compared with levels of AFP and DGCP. RESULTS: In 35 patients (68 sites), CT depicted recurrent HCC (most frequently in lungs [n = 18] and liver allograft [n = 16]) in a single site in 19 patients (54%) and in more than one site in 16 patients (46%). No stage I or II HCC recurred after 18-78 months (mean recurrence, 39 months). Stage IVA HCC recurred four times as often as stage III HCC (P <.001). Abnormally high serum AFP and DGCP levels indicated 69% and 43%, respectively, in patients with recurrent disease. CONCLUSION: HCC recurrence after OLT correlates with initial stage, and CT is more sensitive than serum tumor markers in its detection.