Genomic alterations in hepatocellular carcinoma patients undergoing liver transplantation predict recurrence and prognosis

Background At present, liver transplantation (LT) is currently one of the effective treatments for patients with hepatocellular carcinoma (HCC), but postoperative HCC recurrence is one of the main causes of death in LT recipients. It' s an urgent need to explore biomarkers of recurrence and prognosis of HCC after LT. Methods This study retrospectively and continuously collected 37 patients with HCC who met the Hangzhou criteria (HC) and had undergone LT from January 2019 and July 2021, and each patient underwent whole exome sequencing. Recurrence was defined as recurrence within 365 days after LT, and the 37 patients were classified into the recurrence group (n = 12) and non-recurrence group (n = 25). We analyzed the differences in clinical factors and genomic characters between the two groups. Results We firstly present the genomic mutation spectrum of such patients. No statistically significant between-group differences in the recorded clinical features were detected; MVI was present in 7/12 (58.3%) and 6/25 (24.0%) patients, respectively (two-sided Fisher exact p = 0.0666). Compared with the non-recurrence group, the OS of patients in the recurrence group was significantly worse (p < 0.0001). Univariate analysis identified 304 genes associated with recurrence-free survival (RFS); 205 genes were retained in the multivariate analysis. Multivariate analysis identified 482 genes associated with overall survival (OS) (p < 0.05). Interestingly, we established a 13-gene-model to predict the recurrence risk of such patients. The high-risk group tended to have worse RFS (p = 0.014) and OS (p = 0.01) than the low-risk group. Conclusions For the first time, we explored the correlation between genomic alterations and the recurrence and survival of HCC patients undergoing LT, and also established a 13-gene model with both predictive and prognostic capabilities.