To investigate the clinicopathological factors and survival of patients with primary hepatocellular carcinoma (PHC) with liver transplantation, and to analyze the risk factors affecting their prognosis.

From January 2015 to December 2016, the clinical data of twenty-nine patients with liver transplantation for PHC in Zhongshan People’s Hospital were retrospectively analyzed. Pathological features, clinical outcomes and perioperative effects were analyzed. Life table and Kaplan-Meier method were used for survival analysis of follow-up data, and differential variables were included in Cox regression model analysis to study the related factors affecting the prognosis of liver transplantation patients.

Twenty-five cases received classical orthotopic liver transplantation and four cases received piggyback liver transplantation. The median follow-up time was 23 months, three cases were lost and seven cases died of recurrence. The survival time was 676.5 (26-1 188) days and the survival rate was 73.1% (19/26). Cox regression analysis showed that pathological stage (P=0.018, 95%CI: 1.758-361.593) and lymph node metastasis (P=0.003, 95%CI: 0.019-0.438) were risk factors for prognosis and survival. The prognostic risk of patients with lymph node metastasis increased by 25.216 times, and decreased by 0.092 times for each grade of pathological stage.

Tumor pathological staging and lymph node metastasis are important factors affecting the prognosis of liver transplantation for PHC. To judge the prognosis of liver transplantation for PHC, lymph node metastasis and pathophysiological changes should be considered.