title: Liver transplantation in patients with nonalcoholic steatohepatitis-related hepatocellular carcinoma.
abstract: OBJECTIVE
  The increasing incidence of hepatocellular carcinoma in the United States is only partially accounted for by hepatitis C virus (HCV) infections. The prevalence of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis (NASH) is not known; guidelines from the American Association for the Study of Liver Diseases do not recommend surveillance imaging. We sought to determine the prevalence of hepatocellular carcinoma among patients undergoing liver transplantation for NASH-related cirrhosis and their outcome after surgery, compared with controls.
  
  
  METHODS
  We reviewed the records of adult patients with NASH cirrhosis who underwent liver transplantation by using a prospectively collected database from a single center. Data from patients with NASH cirrhosis were compared with matched controls who received transplantation for primary biliary cirrhosis/primary sclerosing cholangitis, alcoholic liver disease, or HCV.
  
  
  RESULTS
  Seventeen of 98 patients (17%) with NASH cirrhosis were diagnosed with hepatocellular carcinoma. The mean age was 63 years, and 70% were male. Six patients were diagnosed with hepatocellular carcinoma incidentally on explant. Survival after liver transplantation was 88% after mean follow-up of 2.5 years. The number of NASH patients known to have hepatocellular carcinoma before liver transplantation was greater than the number of patients with primary biliary cirrhosis/primary sclerosing cholangitis and comparable to the number of patients with alcoholic liver disease and HCV.
  
  
  CONCLUSIONS
  Patients with NASH cirrhosis are at risk for developing hepatocellular carcinoma; patients with NASH cirrhosis, especially men older than 50 years, should undergo surveillance imaging. Patients with NASH and hepatocellular carcinoma have good outcomes after liver transplantation.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. maliks@upmc.edu
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Malik
authors.forename: Parijat A
authors.initials: PA
authors.lastname: Gupte
authors.forename: Michael E
authors.initials: ME
authors.lastname: de Vera
authors.forename: Jawad
authors.initials: J
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000601:surgery*; D016022:Case-Control Studies; D005234:Fatty Liver / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States