Hepatocellular carcinoma recurrence after acute liver allograft rejection treatment: A multicenter European experience

6533b7d9fe1ef96bd126ce42

RESEARCH PRODUCT

Hepatocellular carcinoma recurrence after acute liver allograft rejection treatment: A multicenter European experience

Jan Lerut Quirino Lai Quirino Lai Maxime Foguenne Maria Hoppe-lotichius Samuele Iesari Samuele Iesari Gerd Otto Armin Finkenstedt Konrad Lehner

subject

Graft Rejection Male Time Factors medicine.medical_treatment Liver transplantation Gastroenterology Acute rejection; Liver biopsy; Liver transplantation; Recurrence; Steroid 0302 clinical medicine Risk Factors Recurrence Prospective cohort study education.field_of_study medicine.diagnostic_test Incidence Incidence (epidemiology)Liver Neoplasms Gastroenterology Immunosuppression Middle Aged Liver biopsy Allografts Europe Treatment Outcome 030220 oncology & carcinogenesis Liver biopsy Hepatocellular carcinoma Acute rejection Female Steroids 030211 gastroenterology & hepatology Immunosuppressive Agents medicine.medical_specialty Carcinoma Hepatocellular Population Risk Assessment 03 medical and health sciences Internal medicine medicine Humans education Steroid Retrospective Studies Liver transplantation Hepatology business.industry medicine.disease Liver Transplantation Transplantation Neoplasm Recurrence Local business

description

During the last decades, several risk factors for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) have been investigated. However, the impact of two important drivers of oncogenesis, namely the immunosuppression and the treatment of acute cellular rejection (ACR) have been marginally addressed. This study aimed at investigating the impact of ACR treatment on the incidence of tumor recurrence in a large European HCC-LT population. Seven hundred and eighty-one adult patients transplanted between February 1, 1985 and June 30, 2016 were retrospectively analyzed. After propensity score match, 116 patients treated for ACR using steroid boluses were compared with 115 patients who did not present any ACR or a histologic but clinical irrelevant ACR. Steroid boluses treated patients had a 18-fold higher overall incidence of HCC recurrence than those non-treated patients (16.4% vs. 0.9%; P<0.0001). At multivariate Cox regression analysis, steroid boluses used to treat ACR were an independent risk factor for HCC recurrence (HR=14.2; 95% CI: 1.8-110.4; P = 0.010). The decision to treat ACR as well as to reinforce immunosuppression load should be cautiously taken in view of the presented results. Prospective studies are needed to further elucidate the clinical impact of immunosuppression on HCC recurrence after transplantation.

year	journal	country	edition	language
2019-01-01	Hepatobiliary & Pancreatic Diseases International

https://doi.org/10.1016/j.hbpd.2019.05.006