الفهرس 
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Abstract
Several treatment options are available to patients with HCC and the ideal option is determined based on the burden of tumour and extent of underlying liver disease. Transplantation and resection remain the major therapeutic options available to patients with HCC. Patients with early-stage disease and advanced cirrhosis, including Child–Pugh class B/C disease and portal hypertension, are thought to be candidates for transplantation, whereas resection remains the treatment of choice in patients without underlying liver disease. (Mazzaferro, et al., 2011)
Liver transplantation is the preferred treatment of early stage hepatocellular carcinoma in the setting of cirrhosis. While long-term survival following liver transplantation now exceeds 70%, disease recurrence remains an issue in a subset of patients and can adversely affect long-term survival. The incidence of recurrent HCC following transplantation has been reported to vary, ranging from 6-56% – perhaps reflecting differences in patient selection for initial transplantation. ( Kakodkar and Soin, 2012)
While several recipient and tumor-specific factors are prognostically important, primary tumor size, number of lesions, and presence of vascular invasion have been noted to be the most significant clinical risk factors for both recurrence and survival. Given this, the overall incidence of recurrence has decreased dramatically since the adoption of the so-called Milan criteria, which ushered in a more stringent selection of HCC patients for transplantation. (Kooby, et al., 2008)
management of patients with recurrent HCC following transplantation is challenging. Although data are scarce, intrahepatic disease can be managed with repeat resection, ablation, transplantation, or IAT therapy. Patients with extrahepatic disease are less likely to benefit from surgical resection. ( Shin, et al., 2010)
Therapeutic options are limited and included administration of sorafenib or use of radiation therapy. While most recurrences occur early after transplant, late recurrences do occur. Many patients with recurrent metastatic HCC face a difficult clinical course. As such, management of patients with recurrent HCC following transplantation are best served being treated by a multi-disciplinary team that includes surgery, transplantation, hepatology, interventional and diagnostic radiology, as well as medical oncology. ( Peter , et al., 2013)