Liver Transplantation for Hepatic Adenoma: A UNOS Database Analysis and Systematic Review of the Literature

Ioannis A Ziogas; Panagiotis T Tasoudis; Nikolaos Serifis; Sophoclis P Alexopoulos; Martin I Montenovo; Alexandra Shingina

doi:10.1097/TXD.0000000000001264

Liver Transplantation for Hepatic Adenoma: A UNOS Database Analysis and Systematic Review of the Literature

Transplant Direct. 2022 Jan 5;8(2):e1264. doi: 10.1097/TXD.0000000000001264. eCollection 2022 Feb.

Authors

Ioannis A Ziogas^{1

2}, Panagiotis T Tasoudis^{2

3}, Nikolaos Serifis^{2

4}, Sophoclis P Alexopoulos¹, Martin I Montenovo¹, Alexandra Shingina⁵

Affiliations

¹ Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
² Surgery Working Group, Society of Junior Doctors, Athens, Greece.
³ School of Health Sciences, University of Thessaly, Larissa, Greece.
⁴ Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
⁵ Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

Abstract

Background: Liver transplantation (LT) has been employed for hepatic adenoma (HA) on a case-oriented basis. We aimed to describe the characteristics, waitlist, and post-LT outcomes of patients requiring LT for HA.

Methods: All patients listed or transplanted for HA in the United States were identified in the United Network for Organ Sharing (UNOS) database (1987-2020). A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.

Results: A total of 199 HA patients were listed for LT in UNOS and the crude waitlist mortality was 9.0%. A total of 142 HA patients underwent LT; 118 of these were among those listed with an indication of HA who underwent LT, and 24 were diagnosed incidentally. Most did not experience hepatocellular carcinoma transformation (89.4%). Over a median follow-up of 62.9 mo, death was reported in 18.3%. The 1-, 3-, and 5-y patient survival rates were 94.2%, 89.7%, and 86.3% in the UNOS cohort. The systematic review yielded 61 articles reporting on 99 nonoverlapping patients undergoing LT for HA and 2 articles reporting on multicenter studies. The most common LT indications were suspected malignancy (39.7%), unresectable HA (31.7%), and increasing size (27.0%), whereas 53.1% had glycogen storage disease. Over a median follow-up of 36.5 mo, death was reported in 6.0% (n=5/84). The 1-, 3-, and 5-y patient survival rates were all 95.0% in the systematic review.

Conclusions: LT for HA can lead to excellent long-term outcomes in well-selected patients. Prospective granular data are needed to develop more optimal selection criteria and further improve outcomes.