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. 2022 Jul 5:35:10175.
doi: 10.3389/ti.2022.10175. eCollection 2022.

Reduced Rates of Post-Transplant Recurrent Hepatocellular Carcinoma in Non-Alcoholic Steatohepatitis: A Propensity Score Matched Analysis

Ryan Lamm  1 , Peter J Altshuler  1 , Keyur Patel  1 , Osama Shaheen  1 , Angel Paulo Amante  1 , Jesse Civan  2 , Warren Maley  1 , Adam Frank  1 , Carlo Ramirez  1 , Jaime Glorioso  1 , Ashesh Shah  1 , Hien Dang  1 , Adam S Bodzin  1
Affiliations

Reduced Rates of Post-Transplant Recurrent Hepatocellular Carcinoma in Non-Alcoholic Steatohepatitis: A Propensity Score Matched Analysis

Ryan Lamm et al. Transpl Int. .

Abstract

Non-alcoholic steatohepatitis (NASH)-related hepatocellular carcinoma (HCC) has become the second leading cause of HCC-related liver transplantation in the United States. This study investigated post-transplant recurrence and survival for patients transplanted for NASH-related HCC compared to non-NASH HCC etiologies. Retrospective review of the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN) database identified 7,461 patients with HCC-1,405 with underlying NASH and 6,086 with non-NASH underlying diseases. After propensity score matching (PSM) to account for patient- and tumor-related confounders 1,175 remained in each group. Primary outcomes assessed were recurrence rate and recurrence-free survival. Recurrent malignancy at 5 years post-transplant was lower in NASH compared to non-NASH patients (5.80 vs. 9.41%, p = 0.01). Recurrence-free survival, however, was similar at 5 years between groups. Patients with NASH-related HCC were less likely to have post-transplant recurrence than their non-NASH counterparts, although recurrence-free survival was similar at 5 years.

Keywords: Organ Procurement and Transplantation Network; United Network for Organ Sharing; hepatocellular carcinoma; non-alcoholic steatohepatitis; recurrence.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study design. NASH transplant recipients with HCC were first compared to non-NASH recipients with HCC. These patients were then propensity matched and further compared. Additional analysis was performed on the unmatched populations to compare with post-transplant HCC recurrence and post-recurrence survival between NASH and non-NASH populations.
FIGURE 2
FIGURE 2
Cumulative incidence of post-transplant HCC recurrence (A) and Kaplan-Meier curves comparing survival (B) in NASH vs PSM non-NASH patients.
FIGURE 3
FIGURE 3
Kaplan-Meier curves comparing survival following recurrence in NASH vs. non-NASH patients.
See this image and copyright information in PMC

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