{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:59:23Z","timestamp":1790690363789,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is uncommon but associated with poor outcomes, requiring effective surveillance. We assessed adherence to and effectiveness of a risk\u2010stratified surveillance protocol and compared it with the RETREAT\u2010guided surveillance protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a single\u2010center retrospective review of patients with HCC on explant after LT (2013\u20132023). Patients were assigned low\u2010 or high\u2010risk surveillance based on explant pathology (AJCC tumor stage, grade, and vascular invasion). Protocol performance, modified surveillance strategies, and comparison with RETREAT across multiple cutoffs were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 480 patients, 55 (11.5%) developed recurrence; 23 (41.8%) of these died, with median post\u2010recurrence survival of 14 months. Only 15.8% were fully adherent, with higher adherence in low\u2010risk patients (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). The protocol appropriately stratified risk (sensitivity 80.0%, specificity 54.1%) and retained substantially higher specificity than RETREAT even at RETREAT's conventional low\u2010risk cutoff (32.0%) despite matching sensitivity; the two systems captured different patients (McNemar's test,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). Extrahepatic disease at recurrence was more common in high\u2010risk patients (56.8%\u00a0vs. 18.2%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.040). Fully adherent patients had earlier recurrence detection (206.4\u00a0vs. 666.9 days,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.015). Modified protocols improved adherence but delayed some diagnoses; most low\u2010risk recurrences occurred within 1 year and high\u2010risk recurrences within 2 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This protocol effectively stratifies recurrence risk and is more sensitive than the RETREAT\u2010guided surveillance protocol. Modified strategies may improve adherence and reduce cost while maintaining effectiveness, particularly in low\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70685","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:09:23Z","timestamp":1790687363000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk\u2010Stratified Surveillance for Recurrent Hepatocellular Carcinoma After Liver Transplantation: A Comparison With the RETREAT\u2010Guided Surveillance Protocol"],"prefix":"10.1111","volume":"40","author":[{"given":"Ishaan P.","family":"Dharia","sequence":"first","affiliation":[{"name":"Henry D. Janowitz Division of Gastroenterology Department of Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Leven","sequence":"additional","affiliation":[{"name":"Recanati Miller Transplantation Institute Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Henry D. Janowitz Division of Gastroenterology Department of Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Waite","sequence":"additional","affiliation":[{"name":"Henry D. Janowitz Division of Gastroenterology Department of Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pu","family":"Ni","sequence":"additional","affiliation":[{"name":"Department of Pathology Mount Sinai West and Morningside  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Isabel","family":"Fiel","sequence":"additional","affiliation":[{"name":"Department of Pathology Molecular and Cell\u2010Based Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo E.","family":"Facciuto","sequence":"additional","affiliation":[{"name":"Recanati Miller Transplantation Institute Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas D.","family":"Schiano","sequence":"additional","affiliation":[{"name":"Recanati Miller Transplantation Institute Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren T.","family":"Grinspan","sequence":"additional","affiliation":[{"name":"Recanati Miller Transplantation Institute Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199603143341104"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14020419"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15697"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15576"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29913"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.20039"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2007.06.042"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2010.02.014"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i39.11185"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/meg.0000000000001448"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/txd.0000000000001086"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14549"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.06.003"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2017.10.011"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102407\u20107\u201028"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14030630"},{"key":"e_1_2_12_18_1","unstructured":"Online Patient Cost Estimator Tool.Mount Sinai Health SystemAccessed February 13 2026 https:\/\/www.mountsinai.org\/about\/insurance\/cost\u2010estimator."},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28770"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/tp.0000000000003117"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers18050721"},{"key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.2147\/JHC.S383474","article-title":"Delayed Hepatocellular Carcinoma Recurrence After Liver Transplantation: Comprehensive Clinical Characterization of Case Series","volume":"9","author":"Wong T.\u2010H.","year":"2022","journal-title":"Journal of Hepatocellular Carcinoma"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70685","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70685","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70685","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:09:24Z","timestamp":1790687364000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ctr.70685"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70685","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-05-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70685"}}