Liver transplantation for NASH-related hepatocellular carcinoma versus non-NASH etiologies of hepatocellular carcinoma

AbstractBackgroundLiver Transplant (LT) for Non-Alcoholic 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) vs. HCC from other liver diseases (non-NASH).MethodsUsing a two-centre retrospective design all patients from 2004-2014 that received LT for HCC were analyzed. Subgroup analysis stratified patients according to Milan criteria.Results929 patients were transplanted for HCC. 60/929 (6.5%) 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 vs. 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, HR 0.21 (0.05-0.86), p=0.029.ConclusionAfter 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 favourable outcomes after LT has been generated, but requires further study. Background Liver Transplant (LT) for Non-Alcoholic 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) vs. HCC from other liver diseases (non-NASH). Methods Using a two-centre retrospective design all patients from 2004-2014 that received LT for HCC were analyzed. Subgroup analysis stratified patients according to Milan criteria. Results 929 patients were transplanted for HCC. 60/929 (6.5%) 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 vs. 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, HR 0.21 (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 favourable outcomes after LT has been generated, but requires further study. Corresponding Author: Dr. Gonzalo Sapisochin, Multi-Organ Transplant. Division of General Surgery, Department of Surgery, University of Toronto, 585 University Avenue, 11-PMB-184, Toronto, ON M5G 2N2, Canada. gonzalo.sapisochin@uhn.ca. T: +1 416 340 5230, F: +1 416 340 5242 Authorship E.M. Sadler - involved in study design, data collation, data analysis, manuscript preparation. N. Mehta – involved in study design, data collection, data analysis, and manuscript review. M. Bhat – involved in study design, manuscript preparation and review. A. Ghanekar – involved in data collection and manuscript review. P.D. Greig – involved in data collection and manuscript review. D.R. Grant – involved in data collection and manuscript review. F. Yao – involved in study design, data collection, and manuscript review. G. Sapisochin – involved in study design, data collection, data analysis, manuscript review. Disclosure The authors declare no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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