PLoS ONE (Jan 2017)

Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impact.

  • Pablo Pérez,
  • Manuel Rodríguez-Perálvarez,
  • Lourdes Guerrero,
  • Víctor González,
  • Rafael Sánchez,
  • Macarena Centeno,
  • Antonio Poyato,
  • Javier Briceño,
  • Marina Sánchez-Frías,
  • Jose Luis Montero,
  • Manuel De la Mata

DOI
https://doi.org/10.1371/journal.pone.0175010
Journal volume & issue
Vol. 12, no. 4
p. e0175010

Abstract

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BACKGROUND:Incidental hepatocellular carcinoma (iHCC) is a histological finding after liver transplantation (LT) which relevance has been scarcely studied. AIMS:to describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival. METHODS:Observational study including 451 consecutive adult LT patients (2000-2013). Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox's regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders. RESULTS:141 patients had known HCC before LT (31.3%). Among the remaining 310 patients, the prevalence of iHCC was 8.7% (n = 27). In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria (p = 0.30). Patients with known and iHCC had similar rates of multinodular disease (50.4% vs 55.6%; p = 0.62), macrovascular invasion (6.5% vs 3.7%; p = 0.58), microvascular invasion (12.9% vs 14.8%; p = 0.76) and moderate-poor tumor differentiation (53.9% vs 70.4%; p = 0.09). In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features (RR = 1.06, 95%CI 0.36-3.14; p = 0.90). Cumulative 5-year overall survival rates were similar between patients with known and iHCC (65% vs 52.8% respectively; log rank p = 0.44), but significantly inferior as compared with patients without HCC (77.8%) (p = 0.002 and p = 0.007 respectively). Indeed, in the overall cohort, iHCC was an independent predictor of mortality (RR = 3.02; 95%CI 1.62-5.65; p = 0.001). CONCLUSION:The risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.