De Novo Hepatocellular Carcinoma Among Liver Transplant Registrants in the Direct Acting Antiviral Era

Kwong, Allison J.; Kim, Woojin; Flemming, Jennifer A.

doi:10.1002/hep.30045

Cited by 8 publications

(11 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The diagnosis of HCC among UNOS registrants was based on HCC Model for End-Stage Liver Disease (MELD) exception application as described. (22) In brief summary, diagnosis of HCC was based on histological or specific imaging criteria (e.g., arterial phase enhancement, venous washout, peripheral rim enhancement, or growth by 50% or more on serial imaging obtained fewer than 6 months apart). To qualify for MELD exception points, the burden of HCC must be either (1) two or three lesions measuring between 1 and 3 cm or (2) a single lesion measuring between 2 and 5 cm.…”

Section: Hcc Ascertainmentmentioning

confidence: 99%

Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease

et al. 2019

View full text Add to dashboard Cite

Diabetes increases the risk of liver disease progression and cirrhosis development in patients with nonalcoholic steatohepatitis (NASH). The association between diabetes and the risk of hepatocellular carcinoma (HCC) in NASH patients with cirrhosis is not well quantified. All patients with the diagnosis of NASH cirrhosis seen at Mayo Clinic Rochester between January 2006 and December 2015 were identified. All adult liver transplant registrants with NASH between 2004 and 2017 were identified using the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation registry for external validation. Cox proportional hazard analysis was performed to investigate the association between diabetes and HCC risk. Among 354 Mayo Clinic patients with NASH cirrhosis, 253 (71%) had diabetes and 145 (41%) were male. Mean age at cirrhosis evaluation was 62. During a median follow‐up of 47 months, 30 patients developed HCC. Diabetes was associated with an increased risk of developing HCC in univariate (hazard ratio [HR] = 3.6; 95% confidence interval [CI] = 1.1‐11.9; P = 0.04) and multivariable analysis (HR = 4.2; 95% CI = 1.2‐14.2; P = 0.02). In addition, age (per decade, HR = 1.8; 95% CI = 1.2‐2.6; P < 0.01) and low serum albumin (HR = 2.1; 95% CI = 1.5‐2.9; P < 0.01) were significantly associated with an increased risk of developing HCC in multivariable analysis. Other metabolic risk factors, including body mass index, hyperlipidemia, and hypertension, were not associated with HCC risk. Among UNOS NASH registrants (N = 6,630), 58% had diabetes. Diabetes was associated with an increased risk of developing HCC in univariate (HR = 1.4; 95% CI = 1.1‐1.8; P < 0.01) and multivariable (HR = 1.3; 95% CI = 1.0‐1.7; P = 0.03) analysis. Conclusion: Diabetes is associated with an increased risk of HCC in patients with NASH cirrhosis.

show abstract

Section: Hcc Ascertainmentmentioning

confidence: 99%

Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease

et al. 2019

View full text Add to dashboard Cite

show abstract

“…An initial small cohort study by Reig et al[25] suggested an increase in rates of HCC following DAA therapy, however a large meta-analysis subsequently found no difference in HCC occurrence in patients following SVR from DAA vs IFN-based treatment[26]. Kwong et al[27] recently showed that although the incidence of de novo HCC in patients with HCV cirrhosis has increased in the DAA era, these changes may be explained by changes in the rates of liver transplantation among HCV patients and wait list mortality. Increasing age and severity of liver disease likely contributes to a higher incidence of HCC in transplant candidates as well[23,27].…”

Section: High Risk Populationsmentioning

confidence: 99%

“…Kwong et al[27] recently showed that although the incidence of de novo HCC in patients with HCV cirrhosis has increased in the DAA era, these changes may be explained by changes in the rates of liver transplantation among HCV patients and wait list mortality. Increasing age and severity of liver disease likely contributes to a higher incidence of HCC in transplant candidates as well[23,27]. Current guidelines continue to recommend HCC surveillance in patients with cirrhosis even after eradication of HCV with DAA therapy[7].…”

Section: High Risk Populationsmentioning

confidence: 99%

Hepatocellular carcinoma surveillance: An evidence-based approach

Harris

Hansen

Gray

et al. 2019

WJG

168

128

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) makes up 75%-85% of all primary liver cancers and is the fourth most common cause of cancer related death worldwide. Chronic liver disease is the most significant risk factor for HCC with 80%-90% of new cases occurring in the background of cirrhosis. Studies have shown that early diagnosis of HCC through surveillance programs improve prognosis and availability of curative therapies. All patients with cirrhosis and high-risk hepatitis B patients are at risk for HCC and should undergo surveillance. The recommended surveillance modality is abdominal ultrasound (US) given that it is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with non-alcoholic fatty liver disease (NAFLD). With the current obesity epidemic and rise in the prevalence of NAFLD, abdominal computed tomography or magnetic resonance imaging may be indicated as the primary screening modality in these patients. The addition of alpha-fetoprotein to a surveillance regimen is thought to improve the sensitivity of HCC detection. Further investigation of serum biomarkers is needed. Semiannual screening is the suggested surveillance interval. Surveillance for HCC is underutilized and low adherence disproportionately affects certain demographics such as non-Caucasian race and low socioeconomic status.

show abstract

“…Patients with a MELD score of more than 18-20 points should be preferably treated post-transplant. Importantly, despite initial concerns, SVR to IFN-free therapies does neither increase the risk of de novo hepatocellular carcinoma (HCC) development [21] nor recurrence of HCC after local ablative therapies [22].…”

Section: Treatment Of Chronic Hepatitis C (Chc) Before and After Oltmentioning

confidence: 99%

Portal Hypertension after Liver Transplantation—Causes and Management

Unger

Mandorfer

Reiberger

2019

Curr Hepatology Rep

View full text Add to dashboard Cite

Purpose of Review While portal hypertension (PHT) treatment strategies for patients with advanced chronic liver disease (ACLD) are well established, studies on the management of PHT after orthotopic liver transplantation (OLT) are limited. This is due to the heterogeneous causes of portal hypertension in the OLT setting. Recent Findings Specific recommendations for the management of non-alcoholic steatohepatitis (NASH), including medical and surgical therapeutic options, and hepatitis C virus (HCV) infection after OLT, are available with most of them applying to transplanted patients. Important concepts to prevent and manage portal vein thrombosis (PVT)-including anticoagulation and TIPS implantation-have been developed. Surgical approaches to resolve PVT, when encountered intraoperatively, have been refined. Finally, interventional treatment options for PHT-related complications and hepatic venous outflow obstruction are available. Summary NASH has a high recurrence rate and causes considerable postoperative morbidity. HCV can be successfully treated in most cases. Specific medical and interventional as well as surgical treatment options are available for PHT after OLT-including for PHT due to surgical complications.

show abstract

De Novo Hepatocellular Carcinoma Among Liver Transplant Registrants in the Direct Acting Antiviral Era

Cited by 8 publications

References 44 publications

Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease

Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease

Hepatocellular carcinoma surveillance: An evidence-based approach

Portal Hypertension after Liver Transplantation—Causes and Management

Contact Info

Product

Resources

About