Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry

Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods:...

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Detalles Bibliográficos
Autores: Pommergaard, Hans-Christian, Arendtsen Rostved, Andreas, Adam, R. (René), Rasmussen, Allan, Salizzoni, Mauro, Gómez Bravo, Miguel Ángel, Cherqui, Daniel, Simone, Paolo De, Houssel-Debry, Pauline, Mazzaferro, Vincenzo, Soubrane, Olivier, García Valdecasas, Juan Carlos, Fabregat Prous, Joan, Pinna, Antonio D., O'Grady, John, Karam, Vincent, Duvoux, Christophe, Thygesen, Lau Caspar, European Liver and Intestine Transplant Association (ELITA)
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/173472
Acceso en línea:https://hdl.handle.net/2445/173472
Access Level:acceso abierto
Palabra clave:Càncer de fetge
Trasplantament d'òrgans
Liver cancer
Transplantation of organs
Descripción
Sumario:Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31-2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.

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