Clinical significance of pulmonary nodules in the pretransplant evaluation of liver transplant recipients with hepatocellular carcinoma

Objectives: Pulmonary nodules are common in patients with hepatocellular carcinoma who are being evaluated for a possible liver transplant. Materials and Methods: In this retrospective study, we analyzed the records of liver transplant recipients at our institution with a primary diagnosis of hepatocellular carcinoma who received transplants between 2000 and 2015. All patients had magnetic resonance imaging-confirmed disease within Milan criteria and a concurrent staging chest computed tomography. Patient survival was estimated using Kaplan-Meier methods and compared between pulmonary nodule characteristic groups. A Cox proportional hazards model was constructed for adjusted analysis. Results: Of the 197 liver transplant recipients who met our study inclusion criteria (median follow-up, 40 mo), 115 (58.4%) had a total of 231 pulmonary nodules, with 57 (49.6%) having multiple nodules and 108 (93.9%) having nodules < 1 cm. The presence of pulmonary nodules did not negatively affect patient survival, per our univariate and multivariate analysis, nor did their presence affect their number, location, laterality, shape, edge, density, or the presence of calcifications (P >.05). However, pulmonary nodules > 1 cm were associated with decreased overall survival. Conclusions: In our pretransplant evaluation of patients with hepatocellular carcinoma, pulmonary nodules < 1 cm did not portend worse patient or graft survival posttransplant.