How would you treat a patient with recurrent metastatic HCC 6 years after liver transplant for HCC?  

Sadly, I have seen recurrence as far out as 10 years in these situations. Given the high risk of organ rejection (some literature report up to 40%) with immunotherapy and the lack of prospective data, I typically start patients with TKI such as lenvatinib or sorafenib depending on the provider's pre...