Comparison of clinical outcomes in chronic hepatitis B liver transplant candidates with and without hepatocellular carcinoma

Stephen N. Wong, Rajender K. Reddy, Emmet B. Keeffe, Steven Huy Han, Paul J. Gagilo, Robert P. Perrillo, Tram T. Tran, Timothy L. Pruett, Anna S.F. Lok, Natalie Bzowcj, Nata Devole, Amy Crumley, Maria Martin, Reymond T. Chung, Diana Tsuli, Marian Bihrle, Michael Ishitani, Linda Lairson, Sukru Emre, Ilhan KarabicakCheryl Denham, Dana Supan, Pearl Kim-Hong, Val Peacock, Consuelo Soldevila-Pico, Joy Peter, Arie Regev, Maria Torres, Rajender Reddy, Elliott Kozin, Timothy Pruett, Meredith Gross, Velimir A.C. Luketic, Stacy McLeod, Terese Howell, Donna Harsh, Amy Randall-Ray, Douglas Armstrong, Munira Hussain, Jim Imus, Morton Brown

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Patients with hepatocellular carcinoma (HCC) receive a higher MELD score and may undergo liver transplantation (OLT) earlier compared to patients with cirrhosis, potentially decreasing waiting list mortality. However, post-OLT survival may be reduced by recurrence of HCC. We compared clinical outcomes between patients with HBV-cirrhosis and no HCC and patients with HBV-HCC. A total of 279 patients (HBV-cirrhosis = 183;HBV-HCC = 96) in the US HBV-OLT study were followed for a median of 30.2 months from listing. Patients with HCC were older, more likely to be Asian, and had less severe liver impairment than patients with HBV-cirrhosis. Despite a higher rate of OLT in patients with HCC (78.1% vs. 51.4%; P < 0,001), intention-to-treat (ITT) survival (73% vs. 78%) and survival without OLT (82% vs. 79%) at 5 years were similar for patients with and without HCC. Cox regression analysis identified higher albumin, lower MELD, no HCC at listing, and being transplanted to be associated with better ITT survival, Ninety-four patients with HCC (including 19 new HCC) and 75 with HBV-cirrhosis underwent OLT. Post-OLT survival (83% vs 90%) and HBV recurrence (11 % vs. 10%) at 3 years were similar, while disease (HBV and/or HCC) recurrence (19% vs. 10%; P = 0.043) was higher in patients with HBV-HCC vs. HBV.cirrhosis. Disease recurrence was the only independent predictor of post-OLT survival. In conclusion, despite more advanced liver disease and a lower rate of transplantation, ITT survival of patients listed for HBV-cirrhosis was comparable to those with HBV-HCC, possibly related to beneficial effects of antiviral therapy.

Original languageEnglish (US)
Pages (from-to)334-342
Number of pages9
JournalLiver Transplantation
Volume13
Issue number3
DOIs
StatePublished - Mar 2007

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