The impact of pre-transplant treatment on post-transplant outcomes in liver transplant patients with hepatocellular carcinoma

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Conference Proceeding

Publication Date


Publication Title

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.





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