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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Autores: Pommergaard, Hans Christian, Rostved, Andreas Arendtsen, Adam, René, Salizzoni, Mauro, Gómez Bravo, Miguel Ángel, Cherqui, Daniel, Thygesen, Lau Caspar
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/144814
Acceso en línea:https://hdl.handle.net/11441/144814
https://doi.org/10.1159/000507397
Access Level:acceso abierto
Palabra clave:Hepatocellular carcinoma
Liver transplantation
Prognosis
Propensity score calibration
Unmeasured confounding
Non-cirrhotic liver ·
Cirrhosis
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spelling Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registryPommergaard, Hans ChristianRostved, Andreas ArendtsenAdam, RenéSalizzoni, MauroGómez Bravo, Miguel ÁngelCherqui, DanielThygesen, Lau CasparHepatocellular carcinomaLiver transplantationPrognosisPropensity score calibrationUnmeasured confoundingNon-cirrhotic liver ·CirrhosisBackground 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.S. Karger AGCirugía2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/144814https://doi.org/10.1159/000507397reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésLiver Cancer, 9 (4), 455-457.http://doi.org/10.1159/000507397info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1448142026-06-17T12:51:07Z
dc.title.none.fl_str_mv Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
title Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
spellingShingle Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
Pommergaard, Hans Christian
Hepatocellular carcinoma
Liver transplantation
Prognosis
Propensity score calibration
Unmeasured confounding
Non-cirrhotic liver ·
Cirrhosis
title_short Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
title_full Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
title_fullStr Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
title_full_unstemmed Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
title_sort Mortality after transplantation for hepatocellular carcinoma: a study from the European liver transplant registry
dc.creator.none.fl_str_mv Pommergaard, Hans Christian
Rostved, Andreas Arendtsen
Adam, René
Salizzoni, Mauro
Gómez Bravo, Miguel Ángel
Cherqui, Daniel
Thygesen, Lau Caspar
author Pommergaard, Hans Christian
author_facet Pommergaard, Hans Christian
Rostved, Andreas Arendtsen
Adam, René
Salizzoni, Mauro
Gómez Bravo, Miguel Ángel
Cherqui, Daniel
Thygesen, Lau Caspar
author_role author
author2 Rostved, Andreas Arendtsen
Adam, René
Salizzoni, Mauro
Gómez Bravo, Miguel Ángel
Cherqui, Daniel
Thygesen, Lau Caspar
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Cirugía
dc.subject.none.fl_str_mv Hepatocellular carcinoma
Liver transplantation
Prognosis
Propensity score calibration
Unmeasured confounding
Non-cirrhotic liver ·
Cirrhosis
topic Hepatocellular carcinoma
Liver transplantation
Prognosis
Propensity score calibration
Unmeasured confounding
Non-cirrhotic liver ·
Cirrhosis
description 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.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/144814
https://doi.org/10.1159/000507397
url https://hdl.handle.net/11441/144814
https://doi.org/10.1159/000507397
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Liver Cancer, 9 (4), 455-457.
http://doi.org/10.1159/000507397
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv S. Karger AG
publisher.none.fl_str_mv S. Karger AG
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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