Prognostic impact of incidentally detected hepatocellular carcinoma in explanted livers after living donor liver transplantation



The impact of incidentally detected hepatocellular carcinoma (iHCC) in explanted liver on the prognosis of the patients undergoing orthotopic liver transplantation remains controversial with several studies reporting survival worse than true non-hepatocellular carcinoma (non-HCC) recipients. Patients undergoing living donor liver transplantation (LDLT) have the benefit of a shorter waiting time to transplant which in principle should reduce the frequency of new tumors developing while waiting for transplant. We aimed to evaluate the incidence, histopathological features, and impact of iHCC on short- and long-term outcomes in adult LDLT recipients.


The present study retrospectively analyzed the patients’ demographics, tumor characteristics, and outcomes of iHCC in adult patients undergoing LDLT for non-HCC indications at our center between August 2009 and March 2018.


Five hundred and forty-five adults underwent LDLT in our center during the study period. iHCC was detected in the explanted livers in 28 patients (5.1%) out of 545 LDLTs. Only one patient had iHCC beyond Milan criteria. No tumor recurrence was observed in the iHCC cohort after a median follow-up of 28 months. Five-year overall and recurrence-free survival was 96.4%.


Incidence of iHCC in explanted livers after LDLT is low and most patients have very early-stage tumors with excellent recurrence-free survival. Hence, no specific post-transplant surveillance or treatment is necessary.

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Author information




Muthukumarassamy Rajakannu: data collection, analysis of data and preparation of the manuscript. Mukul Vij: histology of liver explants. Taheer Mobin Ahmed Shaikh: data collection. Ashwin Rammohan: data collection. Mettu Srinivas Reddy: designed the study and critical revision of manuscript. Mohamed Rela: critical revision of manuscript and final approval.

Corresponding author

Correspondence to Mohamed Rela.

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MR, MV, TMAS, AR, MSR, and MR declare that they have no conflict of interest.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on


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Rajakannu, M., Vij, M., Shaikh, T.M.A. et al. Prognostic impact of incidentally detected hepatocellular carcinoma in explanted livers after living donor liver transplantation. Indian J Gastroenterol (2021).

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  • Chronic liver disease
  • Cirrhosis
  • Hepatocellular carcinoma
  • Liver cancer
  • Liver transplantation
  • Malignancy
  • Non-alcoholic steatohepatitis
  • Prognosis
  • Recurrence
  • Survival
  • Viral hepatitis