HPB : the official journal of the International Hepato Pancreato Biliary Association | 2021
Outcomes of liver transplantation for nonalcoholic steatohepatitis-associated hepatocellular carcinoma.
Abstract
BACKGROUND\nNonalcoholic steatohepatitis-associated hepatocellular carcinoma (NASH-HCC) is the second-leading cause of liver transplantation (LT) performed for HCC. Despite this, little is known about the clinical characteristics and outcomes of NASH-HCC.\n\n\nMETHODS\nPatients undergoing LT for HCC from 2001 to 2017\xa0at a single center were reviewed. Outcomes of NASH-HCC (n\xa0=\xa051) were compared to other etiologies of HCC including hepatitis C (HCV) hepatitis B (HBV), and alcoholic liver disease (ALD). Outcomes of NASH-HCC were also compared to HCV in the direct-acting antiviral (DAA) era (2014-2017).\n\n\nRESULTS\nThe frequency of NASH-HCC as the primary indication for LT in patients with HCC increased significantly during the study period from 4.4% (2001-2008) to 15.6% in 2017. NASH-HCC patients were significantly older (median age 65 vs. 60; P\xa0<\xa00.001) with significantly lower alpha-fetoprotein levels (7.5 vs. 26.5, P\xa0<\xa00.001) compared to other etiologies. The 1-, 3-, and 5-year overall survival of NASH-HCC was 92%, 86%, and 80%. Overall survival of NASH-HCC was not significantly different compared to HCV, HBV, or ALD. Compared to HCV-HCC in the DAA era (n\xa0=\xa099), NASH-HCC had comparable post-LT survival (3-year survival 87% vs. 86%, P\xa0=\xa00.870).\n\n\nCONCLUSION\nIn this large single-center experience of NASH-HCC, we demonstrate favorable outcomes of NASH-HCC following LT comparable to other common etiologies of HCC.