What question did this study set out to answer?

To evaluate the effectiveness of the RETREAT score in predicting HCC recurrence and survival post-liver transplantation.

February 11, 2026Open Access

RETREAT Score Accurately Predicts the Long-Term Risk of HCC Recurrence After Liver Transplantation: A Single-Center Real-Life Validation

Key Points

To evaluate the effectiveness of the RETREAT score in predicting HCC recurrence and survival post-liver transplantation.
Retrospective analysis of adult patients undergoing liver transplantation for HCC from 2000 to 2022.
Median follow-up of 64 months was employed to assess recurrence and survival rates.
Different risk strata (low, medium, high) were categorized based on RETREAT scores.
19% of patients experienced HCC recurrence within a median of 31 months.
Recurrence-free survival was 93%, 78%, and 58% for low-, medium-, and high-risk groups, respectively (p < 0.001).
The 5-year survival rates were 95%, 86%, and 61% for low-, medium-, and high-risk groups, respectively.

Abstract

Background: Liver transplantation (LT) for Hepatocellular carcinoma (HCC) is still burdened by a significant risk of tumor recurrence. The aim of this study was to apply the Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score for prediction of HCC recurrence and survival. Methods: This retrospective study included all adult patients who consecutively underwent LT for HCC from January 2000 to July 2022 at a single institution. Results: During a median follow-up of 64 months, 56 (19%) out of 298 patients 54%, 36% and 10% with a RETREAT score equal to 0/1 (low), 2/3 (medium) and 4–6 (high), respectively experienced HCC recurrence after a median of 31 months. The HCC recurrence rates at 1, 5 and 10 years were respectively 4%, 16% and 23%. The 5-year RFS for low-, medium- and high-risk groups were 93%, 78% and 58% (p < 0.001), respectively. In the competitive risk analysis, the medium- and high-risk RETREAT groups had respectively a 2.3 HR (p = 0.017) and 6.4 HR (p < 0.001) of HCC recurrence compared with the low-risk group. Overall, 119 patients died 32 (27%) due to HCC recurrence, and the 5-year survival was 74% (95%, 86% and 61% for low-, medium- and high-risk groups, respectively). In the multivariate analysis, the RETREAT score was associated with the overall survival only for the highest risk class, which yielded a 2.5 HR of death compared with the lowest risk categories (p < 0.001). Conclusions: This study validates the RETREAT score and confirms its ability to predict the risk of HCC recurrence.

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