Background/Objectives: Salvage liver transplantation (SLT) is a well-established option for hepatocellular carcinoma (HCC) recurrence after liver resection. Laparoscopic microwave ablation (L-MWA) represents another curative strategy for early-stage HCC. However, its role within this therapeutic framework remains unexplored.Methods: Between 2014 and 2023, we treated 1341 patients with HCC using L-MWA. From this cohort, patients with Child-Pugh class A liver function, HCC within the Milan criteria, no contraindications to transplantation, and ≥12 months of follow-up were selected. SLT failure was defined as non-transplantable recurrence or death, resulting in the loss of a potentially curative therapeutic opportunity. The primary endpoint was overall survival (OS); secondary endpoints included predictors of survival and SLT failure.Results:A total of 341 patients met the inclusion criteria. Five-year OS was 62%. Independent predictors of poorer survival included the presence of cardiac disease or oesophageal varices, a Child-Pugh score of 6, tumour size, and elevated alpha-fetoprotein (AFP) levels. Treatment was successful in 255 patients (74.8%): 102 (29.9%) underwent SLT, 67 (19.6%) received alternative therapies, and 93 (27.3%) remained recurrence-free. Treatment failure occurred in 86 patients (25.2%) due to non-transplantable recurrence or death. Independent predictors of failure included older age, non-HBV aetiology, and elevated AFP levels. Five-year OS rates were 79% in the success group and 22% in the failure group (p< 0.001).Conclusions: A combined L-MWA and SLT strategy is safe and effective, yielding a 62% 5-year OS rate. This approach supports more efficient graft use with a consequent increase in the population transplant benefit. Improved selection may further reduce failure rates.
背景/目的：挽救性肝移植（SLT）是肝细胞癌（HCC）肝切除术后复发的一种成熟治疗选择。腹腔镜微波消融（L-MWA）是早期HCC的另一种根治性策略。然而，该疗法在此治疗框架中的作用尚未明确。方法：2014年至2023年间，我们采用L-MWA治疗了1341例HCC患者。从该队列中，筛选出肝功能Child-Pugh A级、符合米兰标准、无移植禁忌症且随访≥12个月的患者。SLT失败定义为出现不可移植的复发或死亡，导致丧失潜在根治性治疗机会。主要终点为总生存期（OS）；次要终点包括生存及SLT失败的预测因素。结果：共341例患者符合纳入标准。5年OS为62%。生存较差的独立预测因素包括合并心脏病或食管静脉曲张、Child-Pugh评分6分、肿瘤体积较大及甲胎蛋白（AFP）水平升高。255例患者（74.8%）治疗成功：其中102例（29.9%）接受了SLT，67例（19.6%）接受了替代治疗，93例（27.3%）保持无复发状态。86例患者（25.2%）因出现不可移植的复发或死亡导致治疗失败。失败的独立预测因素包括年龄较大、非HBV病因及AFP水平升高。成功组与失败组的5年OS率分别为79%和22%（p<0.001）。结论：L-MWA联合SLT策略安全有效，可获得62%的5年OS率。该方法有助于更高效地利用供肝，从而增加移植获益人群。优化患者筛选可能进一步降低失败率。
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