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

Hans-Christian Pommergaard, Andreas Arendtsen Rostved, René Adam, Mauro Salizzoni, Miguel Angel Gómez Bravo, Daniel Cherqui, Paolo De Simone, Pauline Houssel-Debry, Vincenzo Mazzaferro, Olivier Soubrane, Juan Carlos García-Valdecasas, Joan Fabregat Prous, Antonio D. Pinna, John O'Grady, Vincent Karam, Christophe Duvoux, Lau Caspar Thygesen

Research output: Contribution to journalArticlepeer-review

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.
Original languageEnglish
Pages (from-to)455-467
Number of pages13
JournalLiver Cancer
Volume9
Issue number4
DOIs
Publication statusPublished - 2020

Keywords

  • Prognosis
  • Liver transplantation
  • Hepatocellular carcinoma
  • Cirrhosis
  • Non-cirrhotic liver
  • Propensity score calibration
  • Unmeasured confounding

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