Is recurrence rate of incidental hepatocellular carcinoma after liver transplantation similar to previously known HCC? Towards a predictive recurrence score

Piñero, Federico; Mendizábal, Manuel; Casciato, Paola; Galdame, Omar; Quirós, Rodolfo; Bandi, Juan Carlos; Mullen, Eduardo; Andriani, Oscar; Santibañés, Eduardo de; Podestá, Luis G.; Gadano, Adrián; Silva, Marcelo

doi:10.1016/s1665-2681(19)30884-1

Cited by 12 publications

(17 citation statements)

References 24 publications

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“…In the present study, iHCC patients were older, had worsened liver function, and more complications derived from portal hypertension than patients undergoing LT without HCC. These findings are in line with previous reports [12, 13, 16, 19, 25]. In addition, patients with iHCC had more frequently chronic hepatitis C, as previously shown in some series [12, 15].…”

Section: Discussionsupporting

confidence: 93%

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Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact

et al. 2017

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BackgroundIncidental hepatocellular carcinoma (iHCC) is a histological finding after liver transplantation (LT) which relevance has been scarcely studied.Aimsto describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival.MethodsObservational study including 451 consecutive adult LT patients (2000–2013). Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox’s regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders.Results141 patients had known HCC before LT (31.3%). Among the remaining 310 patients, the prevalence of iHCC was 8.7% (n = 27). In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria (p = 0.30). Patients with known and iHCC had similar rates of multinodular disease (50.4% vs 55.6%; p = 0.62), macrovascular invasion (6.5% vs 3.7%; p = 0.58), microvascular invasion (12.9% vs 14.8%; p = 0.76) and moderate-poor tumor differentiation (53.9% vs 70.4%; p = 0.09). In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features (RR = 1.06, 95%CI 0.36–3.14; p = 0.90). Cumulative 5-year overall survival rates were similar between patients with known and iHCC (65% vs 52.8% respectively; log rank p = 0.44), but significantly inferior as compared with patients without HCC (77.8%) (p = 0.002 and p = 0.007 respectively). Indeed, in the overall cohort, iHCC was an independent predictor of mortality (RR = 3.02; 95%CI 1.62–5.65; p = 0.001).ConclusionThe risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.

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Section: Discussionsupporting

confidence: 93%

“…Therefore, the more prevalent iHCC is, the less impact in terms of tumor recurrence may be expected. For instance, in the study by Piñero et al, 28% of the HCC patients had iHCC, and only 7% of these experienced tumor recurrence at 5 years[16]. In contrast, another report showing a reduced prevalence of iHCC (ie.…”

Section: Discussionmentioning

confidence: 99%

Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact

et al. 2017

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“…Although some authors reported an incidence of iHCC higher than 15% in non-HIV1 LT patients, (15,16) most of the previous reports observed a frequency of iHCC approximately 5% or even lower. (5,6,8,9,11) Hence, our results are congruent with the existing evidence.…”

Section: Discussionsupporting

confidence: 92%

“…Many reports have assessed the incidence and main outcomes of incidental hepatocellular carcinoma (iHCC) in patients without HIV infection . The presence of iHCC in explanted liver varies widely between 1% and 17%, and controversy exists concerning its impact on the outcomes of LT recipients with a highly variable incidence of tumor recurrence after LT reported in studies addressing this issue, ranging from 0% to 33% . Conversely, there is no information on iHCC in the setting of HIV infection.…”

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confidence: 99%

“…(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) The presence of iHCC in explanted liver varies widely between 1% and 17%, (5,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and controversy exists concerning its impact on the outcomes of LT recipients (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) with a highly variable incidence of tumor recurrence after LT reported in studies addressing this issue, ranging from 0% to 33%. (5,6,8,9,(12)(13)…”

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confidence: 99%

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Human immunodeficiency virus–infected liver transplant recipients with incidental hepatocellular carcinoma: A prospective multicenter nationwide cohort study

et al. 2017

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There is a lack of data on incidental hepatocellular carcinoma (iHCC) in the setting of liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients. This study aims to describe the frequency, histopathological characteristics, and outcomes of HIV+ LT recipients with iHCC from a Spanish multicenter cohort in comparison with a matched cohort of LT patients without HIV infection. A total of 15 (6%) out of 271 patients with HIV infection who received LT in Spain from 2002 to 2012 and 38 (5%) out of the 811 HIV- counterparts presented iHCC in liver explants (P = 0.58). Patients with iHCC constitute the present study population. All patients also had hepatitis C virus (HCV)-related cirrhosis. There were no significant differences in histopathological features of iHCC between the 2 groups. Most patients showed a small number and size of tumoral nodules, and few patients had satellite nodules, microvascular invasion, or poorly differentiated tumors. After a median follow-up of 49 months, no patient developed hepatocellular carcinoma (HCC) recurrence after LT. HIV+ LT recipients tended to have lower survival than their HIV- counterparts at 1 (73% versus 92%), 3 (67% versus 84%), and 5 years (50% versus 80%; P = 0.06). There was also a trend to a higher frequency of HCV recurrence as a cause of death in the former (33% versus 10%; P = 0.097). In conclusion, among LT recipients for HCV-related cirrhosis, the incidence and histopathological features of iHCC in HIV+ and HIV- patients were similar. However, post-LT survival was lower in HIV+ patients probably because of a more aggressive HCV recurrence. Liver Transplantation 23 645-651 2017 AASLD.

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The First Six Months Following Liver Transplantation

Reddy

Mendizábal

2017

Schiff's Diseases of the Liver

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Is recurrence rate of incidental hepatocellular carcinoma after liver transplantation similar to previously known HCC? Towards a predictive recurrence score

Cited by 12 publications

References 24 publications

Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact

Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact

Human immunodeficiency virus–infected liver transplant recipients with incidental hepatocellular carcinoma: A prospective multicenter nationwide cohort study

The First Six Months Following Liver Transplantation

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