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Abstract Details
Liver Transplantation for NASH-Related Hepatocellular Carcinoma Versus Non-NASH Etiologies of Hepatocellular Carcinoma
Erin M Sadler12, Neil Mehta3, Mamatha Bhat14, Anand Ghanekar12, Paul D Greig12, David R Grant12, Francis Yao3, Gonzalo Sapisochin12
Author information
1Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
2Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
3Department of Gastroenterology, University of California San Francisco, San Francisco, CA.
4Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
Background: Liver transplant (LT) for nonalcoholic steatohepatitis (NASH) related hepatocellular carcinoma (HCC) is not well characterized in the literature. The aim of the study was to examine characteristics and outcomes of patients who had LT for NASH-HCC (NASH) versus HCC from other liver diseases (non-NASH).
Methods: Using a 2-center retrospective design, all patients from 2004 to 2014 that received LT for HCC were analyzed. Subgroup analysis stratified patients according to Milan criteria.
Results: Nine hundred twenty-nine patients were transplanted for HCC. Sixty (6.5%) of 929 had HCC in the context of NASH. There were no significant differences between groups for pretransplant or explant tumor characteristics. The actuarial 1-, 3- and 5-year overall survival was 98%, 96%, and 80% in NASH versus 95%, 84%, and 78% in non-NASH (P = 0.1). No differences in tumor recurrence were observed in patients within and beyond Milan in the NASH group. Multivariate Cox regression demonstrated NASH status to be a protective factor for recurrence among patients with tumors beyond Milan (hazard ratio, 0.21; 95% confidence interval, 0.05-0.86; P = 0.029).
Conclusion: After LT, outcomes are similar between NASH and non-NASH etiologies for HCC. The hypothesis that patients with more advanced HCC tumors in the context of NASH may have more favorable outcomes after LT has been generated, but requires further study.