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Liver Transplantation for NASH-Related Hepatocellular Carcinoma Versus Non-NASH Etiologies of Hepatocellular Carcinoma

Sadler, Erin, M., MD1,2; Mehta, Neil, MD3; Bhat, Mamatha, MD1,4; Ghanekar, Anand, MD, PhD1,2; Greig, Paul, D., MD1,2; Grant, David, R., MD1,2; Yao, Francis, MD3; Sapisochin, Gonzalo, MD1,2

doi: 10.1097/TP.0000000000002043
Original Clinical Science—Liver

Background Liver transplant (LT) for nonalcoholic 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) versus HCC from other liver diseases (non-NASH).

Methods Using a 2-center retrospective design, all patients from 2004 to 2014 that received LT for HCC were analyzed. Subgroup analysis stratified patients according to Milan criteria.

Results Nine hundred twenty-nine patients were transplanted for HCC. Sixty (6.5%) of 929 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 versus 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 (hazard ratio, 0.21; 95% confidence interval, 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 favorable outcomes after LT has been generated, but requires further study.

The authors explored the relationship between NASH and non-NASH-derived HCC and posttransplant recurrence and survival. A protective effect was detected for NASH etiology for subjects beyond Milan criteria.

1 Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.

2 Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

3 Department of Gastroenterology, University of California San Francisco, San Francisco, CA.

4 Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Received 12 July 2017. Revision received 5 October 2017.

Accepted 3 November 2017.

The authors declare no funding or conflicts of interest.

E.M.S. was involved in study design, data collation, data analysis, article preparation. N.M. was involved in study design, data collection, data analysis, and article review. M.B. was involved in study design, article preparation, and review. A.G. was involved in data collection and article review. P.D.G. was involved in data collection and article review. D.R.G. was involved in data collection and article review. F.Y. was involved in study design, data collection, and article review. G.S. was involved in study design, data collection, data analysis, article review.

Correspondence: Gonzalo Sapisochin, MD, Multi-Organ Transplant, Division of General Surgery, Department of Surgery, University of Toronto, 585 University Ave, 11-PMB-184, Toronto, ON, Canada M5G 2N2. (gonzalo.sapisochin@uhn.ca).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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