Intention‐to‐treat analysis of liver transplantation for hepatocellular carcinoma: The impact of pre‐existing diabetes mellitus

Abstract

Background & Aims Diabetes mellitus is known to negatively impact the outcome of liver transplant; however, data are scarce regarding risk of waitlist dropout and tumour recurrence in patients with hepatocellular carcinoma. We examined the impact of diabetes mellitus on the outcomes of candidates with hepatocellular carcinoma on an intention‐to‐treat basis. Methods Our study included 15 776 candidates with hepatocellular carcinoma diagnosis on the Scientific Registry of Transplant Recipients database from 2008 to 2015 to evaluate the risk of waitlist dropout, hepatocellular carcinoma recurrence and overall survival. Results There were more patients dropped out from the waiting list owing to patient disease deterioration or tumour progression in the diabetes mellitus group (15.1% vs 13.7%, P = 0.024). The mean waiting time was similar in the two groups (233 days vs 230 days, P = 0.631). The recurrence rate was higher in the diabetes mellitus group (9.0% vs 6.2%, P < 0.001); however, the mean time to recurrence in the two groups was similar (23.7 months vs 22.6 months, P = 0.371). Diabetes mellitus, tumours exceeding Milan criteria, and AFP >400 ng/mL were independent predictive factors for recurrence. On an intention‐to‐treat basis, diabetes mellitus was also an independent poor prognostic factor for overall survival; however, the overall survival was comparable with tumours beyond Milan criteria. Conclusions Diabetes mellitus was associated with poor survival outcomes and an increased risk of waitlist dropout and tumour recurrence rates in hepatocellular carcinoma patients. Those patients should be paid more attention to cardiovascular and oncological examination when determining waitlist and post‐transplant surveillance strategies.

ALBI grade in dialysis patients with hepatocellular carcinoma: prognostic impact and staging strategy

“…The cause of dialysis related to DM is another predictor of poor outcome compared with those with non-diabetes related dialysis. The exact mechanism remains unclear; however, in accordance with previous studies, DM was regarded as a predictor of poor survival in dialysis HCC patients (26)(27)(28).…”

Life Expectancy After Liver Transplantation for Hepatocellular Carcinoma With Cirrhosis

“…The corresponding life expectancies would be several years higher than these medians, and thus keeping with the results shown in Table 2, for example, though neither of the aforementioned studies is specific to HCC patients. Other studies such as Li et al 28 and Malik et al 29 do not report separately by age, so it is less feasible to compare with the age-specific figures given here.…”

The prognostic role of diabetes mellitus type 2 in the setting of hepatocellular carcinoma: a systematic review and meta-analysis

“…A total of 23 (85.2%) studies investigated the risk of death after any HCC treatment ( Table 1 ) ( 18 - 27 , 29 - 37 , 40 - 42 , 44 ). Tumor recurrence was investigated in 14 (51.9%) studies ( Table 2 ) ( 19 , 21 , 22 , 24 , 27 , 28 , 30 , 31 , 35 , 37 , 39 - 41 , 43 ), while the risk of progressive disease was reported in 7 (25.9%) studies ( Table 3 ) ( 18 , 26 , 37 , 38 , 41 , 42 , 44 ). Overall, 5 (18.5%) studies had sample sizes of more than 1000 patients ( 25 , 34 , 37 , 41 , 44 ).…”

“…Only a study by Di Costanzo et al ( 38 ) showed longer time-to-progression (10 months vs 9 months) in 80 diabetic HCC patients treated with sorafenib compared with 233 non-diabetic HCC patients ( 38 ). Other six studies reporting data on HCC progression ( 17 , 25 , 36 , 40 , 41 , 43 ) showed an increased diabetes-associated risk (26 358 patients with vs 82 893 without diabetes) on HCC progression.…”

“…Overall, 14 included studies reported data on HCC recurrence ( 19 , 21 , 22 , 24 , 27 , 28 , 30 , 31 , 35 , 37 , 39 - 41 , 43 ). Robust evidence confirmed that diabetes increased HCC recurrence risk, irrespective of treatment.…”