Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5 had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95 confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95 CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95 CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95 CI 1.31-2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.

Mortality after Transplantation for Hepatocellular Carcinoma : A Study from the European Liver Transplant Registry / H.C. Pommergaard, A.A. Rostved, R. Adam, M. Salizzoni, M.A.G. Bravo, D. Cherqui, P. De Simone, P. Houssel-Debry, V. Mazzaferro, O. Soubrane, J.C. Garcia-Valdecasas, J.F. Prous, A.D. Pinna, J. O'Grady, V. Karam, C. Duvoux, L.C. Thygesen. - In: LIVER CANCER. - ISSN 2235-1795. - 9:4(2020 Aug), pp. 455-467. [10.1159/000507397]

Mortality after Transplantation for Hepatocellular Carcinoma : A Study from the European Liver Transplant Registry

V. Mazzaferro;
2020

Abstract

Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5 had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95 confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95 CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95 CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95 CI 1.31-2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
Cirrhosis; Hepatocellular carcinoma; Liver transplantation; Non-cirrhotic liver; Prognosis; Propensity score calibration; Unmeasured confounding
Settore MED/18 - Chirurgia Generale
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/839891
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