The impact of pre-transplant treatment on post-transplant outcomes in liver transplant patients with hepatocellular carcinoma
Shimada S, Kitajima T, Shamaa T, Ivanics T, Adhnan M, Moonka D, Collins K, Rizzari M, Yoshida A, Abouljoud M, and Nagai S. The impact of pre-transplant treatment on post-transplant outcomes in liver transplant patients with hepatocellular carcinoma. Am J Transplant 2022; 22:87-87.
Am J Transplant
Background: Liver transplant (LT) candidates with hepatocellular carcinoma (HCC) often receive pre-transplant treatments for HCC. We aimed to investigate the impact of pre-LT treatment on post-LT outcome in patients with HCC.
Methods: We evaluated adult LT patients with HCC between 2013 and 2020. We investigated the impact of 1) treatment response, and 2) number of pre-LT treatment on the recurrence of HCC by using Gray’s test and Fine-Gray’s test to create bivariable model for risk adjustment.
Results: Of the 179 patients eligible, 28 patients had no pre-LT treatment (Group A). Forty-two patients showed pathologically complete response (pCR). 1) After excluding Group A, patients with pCR showed a significantly lower recurrence rate than those without pCR (P=0.03) (Figure 1). pCR was an independent favorable factor for recurrence (aHR 0.22, 95%CI 0.05-0.97, P=0.04) (Table 1). There were 2 patients with pCR showed recurrence. 2) After excluding patients showed pCR, there were 70 patients had single episode of pre-LT treatment (Group B), and 39 patients had multiple episodes (Group C). While recurrence rates in Groups A and B were similar (P=0.90), Group C showed a significantly higher recurrence rate than Groups A or B (P=0.004 and <0.001) (Figure 2). Group C was an independent risk factor for recurrence (Table 2).
Conclusion: Because significantly worse post-LT outcome was observed in patients with multiple pre-LT treatment episodes, it might be better to proceed with early LT for patients with HCC.