Life Expectancy after Liver Transplantation for Non-Cirrhotic Hepatocellular Carcinoma

Abstract

Background: Hepatocelluar carcinoma typically occurs with underlying cirrhosis. However roughly 20% of cases arise in a non-cirrhotic liver. There is limited literature that addresses the long-term survival of the narrow subgroup who received transplantation. For such patients we sought to calculate life expectancies both at time of transplant and several years later, stratified by key risk factors, and to determine if survival has improved in recent years. Such information can be helpful in making treatment decisions. Methods: Data on 4,373 non-cirrhotic HCC patients who underwent liver transplantation in the MELD era (2002-2018) from the United States OPTN database were analyzed using the Cox proportional hazards regression model and life table methods. Results: Demographic and past medical history factors related to survival were patient age, donor age over 20, and the presence of ascites or severe hepatic encephalopathy. Survival did not vary by race or sex. HCC-specific factors significantly related to survival were the total number of tumors, extrahepatic spread, lymph node involvement, satellite lesions, micro- or macrovascular invasion, tumor differentiation (grade), and pre-transplant treatment. Survival improved over the study period, at 4% per calendar year during the first 5 years post transplant and 1% per year thereafter. Conclusions: Life expectancy in non-cirrhotic HCC transplant patients is much reduced from normal, and varies according to age and tumor-related factors. Survival improved modestly over the study period.

Life Expectancy after Liver Transplantation for NASH

“…The life expectancies given here for NASH patients were modestly higher than those given in prior studies on life expectancy after transplant for HCC 16,17 or alcohol related liver disease (ALD). 18 For example, for males aged 40 we report 20 years, while the three prior studies indicated 16 (HCC with cirrhosis), 15 (HCC without cirrhosis), and 17 (ALD), respectively.…”

“…Secondly, among the 557 (9%) of patients who were of normal weight (body mass index (BMI) 18-25), we found that 5 were underweight when placed on the transplant registration, 18 were overweight, and the remaining 534 were of normal weight. Thirdly, the 5% of patients with HCC were found to have lower MELD scores than the overall group (for example, 26% had scores 6-10% and 39% had scores [11][12][13][14][15][16][17][18], though this finding should be viewed with caution as 47% of patients had missing information with respect to the presence of HCC. Fourthly, there were too few patients of other races (12% Hispanic, 2% Black) to report results separately by race, and indeed a detailed study of the effect of race is outside the scope of the present work.…”

Life Expectancy After Liver Transplantation for Alcoholic Cirrhosis

“…The life expectancies given here for ALD patients are similar to those given in two prior studies on life expectancy after transplant for HCC. 19,20 For example, for males aged 40 we report 17 years, while the two prior studies indicated 15 (HCC with cirrhosis), and 16 (NC-HCC), respectively.…”

“…The methods are similar to our work in two prior studies. 19,20 We identified and followed a cohort of ALD liver transplant patients in the United States to identify factors related to survival and to calculate life expectancies for various subgroups. We used standard methods of survival analysis and life table construction.…”

“…The calculation of life expectancy requires long-term follow-up of persons and the use of life table methodology, the latter having thus far seen rather limited application in transplant research. 19,20 The Organ Procurement and Transplantation Network (OPTN) data 21 includes the requisite lengthy follow up, and the methods used here are standard. In the present study we calculate life expectancy for select ALD patient subgroups, both from the time of initial transplant and also conditioned upon patient survival to 1- or 5- years posttransplant.…”