Adjuvant treatment after orthotopic liver transplantation: is it really necessary?

Hepatocellular cancer (HCC) is a major cause of mortality. Management approaches including surgical and locoregional strategies such as transarterial chemoembolization, radiofrequency ablation, ethanol injections, transarterial chemotherapy infusion, and systemic chemotherapy have proved to be disappointing. Orthotopic liver transplantation (OLT) continues to give patients the best chance for cure, but recurrence of the disease remains a problem. Several investigators have looked into the value of adjuvant chemotherapy in HCC with or without other local neoadjuvant treatment modalities after OLT. Studies have looked at various treatment modalities, but overall results have been disappointing. No adjuvant treatment is currently advocated after OLT in HCC. This review summarizes the current data on efficacy and rationale of adjuvant treatment for HCC after OLT, as well as future prospects.