Outcomes of liver transplantation in non-alcoholic steatohepatitis (NASH) versus non-NASH associated hepatocellular carcinoma

Luckshi Rajendran; Carla F Murillo Perez; Tommy Ivanics; Marco P A W Claasen; Bettina E Hansen; David Wallace; Peter D Yoon; Gonzalo Sapisochin

doi:10.1016/j.hpb.2023.01.019

Outcomes of liver transplantation in non-alcoholic steatohepatitis (NASH) versus non-NASH associated hepatocellular carcinoma

HPB (Oxford). 2023 May;25(5):556-567. doi: 10.1016/j.hpb.2023.01.019. Epub 2023 Feb 3.

Authors

Luckshi Rajendran¹, Carla F Murillo Perez², Tommy Ivanics³, Marco P A W Claasen⁴, Bettina E Hansen², David Wallace⁵, Peter D Yoon⁶, Gonzalo Sapisochin⁷

Affiliations

¹ Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada. Electronic address: https://twitter.com/luckseee.
² Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Toronto Centre for Liver Disease, University Health Network, Toronto, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada.
³ Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Department of Surgery, Henry Ford Hospital, Detroit, MI, USA; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden. Electronic address: https://twitter.com/ivanics_t.
⁴ Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands. Electronic address: https://twitter.com/claasen_m.
⁵ Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, United Kingdom.
⁶ Multi-Organ Transplant Program, University Health Network, Toronto, Canada; Department of Surgery, Westmead Hospital, Sydney, Australia.
⁷ Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Canada; Multi-Organ Transplant Program, University Health Network, Toronto, Canada. Electronic address: Gonzalo.sapisochin@uhn.ca.

PMID: 36828740
DOI: 10.1016/j.hpb.2023.01.019

Abstract

Background: Non-alcoholic steatohepatitis (NASH)-associated hepatocellular carcinoma (HCC) is a rising indication for liver transplantation. This unique population, with multiple comorbidities, has potential for worse post-transplant outcomes. We compared post-transplant survival of NASH and non-NASH HCC patients using a large cohort.

Methods: Adults transplanted for HCC between 2008 and 2018, from United Network for Organ Sharing (UNOS) and University Health Network (UHN) databases were divided into two populations: NASH and non-NASH. Recipient characteristics and post-transplant survival were compared. Subgroup analyses were performed within and beyond Milan criteria.

Results: 2071 of 20,672 (10.0%) patients underwent transplantation for NASH HCC, with annual proportional increase of 1.2%UHN (p = 0.02) and 1.3%UNOS (p < 0.001). The 1-,3-,5-year post-transplant survival were 90.8%, 83.9%, 76.3% NASH HCC versus 91.9%, 82.1%, 74.9% non-NASH HCC (p = 0.94). No survival differences were observed in populations within or beyond Milan. Competing-risk analysis demonstrated no differences in risk for cardiovascular-related death (HR1.24, 95%CI 0.87-1.55, p = 0.16), or HCC recurrence-related death (HR1.21, 95%CI 0.89-1.65, p = 0.23). NASH HCC patients had lower risk of liver-related deaths (HR0.57, 95%CI 0.34-0.98, p = 0.04).

Discussion: NASH HCC is a rising indication for liver transplantation. Despite demographic differences, no post-transplantation survival differences were observed between NASH and non-NASH HCC. This justifies equivalent organ allocation, irrespective of NASH status.

MeSH terms

Adult
Carcinoma, Hepatocellular*
Humans
Liver Neoplasms*
Liver Transplantation* / adverse effects
Non-alcoholic Fatty Liver Disease* / surgery
Retrospective Studies
Treatment Outcome