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The univariate analysis showed that a tumor number >10, a recurrence within six?months, bone metastasis at initial diagnosis, and multi-organ involvement at initial diagnosis all correlated with early ( http://www.selleckchem.com/products/pifithrin-alpha.html We excluded the data from patients with recurrences involving the lung only, liver only, or another single organ, since the extent of recurrence significantly affected patient survival. Among them, we further excluded three patients who received IV chemotherapy in early series, since this might distort the effect of systemic therapy based on sirolimus and sorafenib. Finally 42 patients with recurrence involving multiple organs were enrolled. The one-, two-, and three-yr survival rates after diagnosis of recurrence for patients with multiple-organ recurrences were 38%, 9%, and 0%, respectively in the local treatment group, 60%, 20%, and 0%, respectively, in the systemic treatment group, and 73%, 65%, and 25%, respectively, in the combined treatment group (Fig.?2). The six patients who did not receive any treatment showed the worst survival rate. (one-, two-, and three-yr survival were 17%, 0%, and 0%, respectively.) However, since this might be the result of selection bias due to the retrospective design of study, this was not specified in Fig.?2. LT is performed liberally worldwide, but until now, no consensus has been reached regarding the expanded indications for LT in patients with HCC. For this reason, transplantation teams will be called upon to provide proper care for a growing number of patients with recurrent HCC after LT. Several reports about recurrent HCC after LT have been published, but these studies evaluated only small numbers of patients with recurrent HCC after LT. In contrast, our study is based on the largest number of patients ever reported. Several reports have been published recently about the prognostic factors for recurrent HCC after LT [5, 8, 10]. Vascular invasion and histological grade were considered to be important independent prognostic factors along with tumor size and number [13, 14]. In our data, recurrence within six?months and initial multi-organ involvement were independent risk factors for early (