A comparison of survival and pathologic features of non-alcoholic steatohepatitis and hepatitis C virus patients with hepatocellular carcinoma.
OBJECTIVE
To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis (NASH) patients with hepatocellular carcinoma (HCC) and hepatitic C virus (HCV) patients with HCC (another group in which HCC is commonly seen) undergoing liver transplantation.


METHODS
Patients transplanted for HCV and NASH at our institution from January 2000 to April 2011 were analyzed. All explanted liver histology and pre-transplant liver biopsies were examined by two specialist liver histopathologists. Patient demographics, disease free survival, explant liver characteristics and HCC features (tumour number, cumulative tumour size, vascular invasion and differentiation) were compared between HCV and NASH liver transplant recipients.


RESULTS
A total of 102 patients with NASH and 283 patients with HCV were transplanted. The incidence of HCC in NASH transplant recipients was 16.7% (17/102). The incidence of HCC in HCV transplant recipients was 22.6% (64/283). Patients with NASH-HCC were statistically older than HCV-HCC patients (P < 0.001). A significantly higher proportion of HCV-HCC patients had vascular invasion (23.4% vs 6.4%, P = 0.002) and poorly differentiated HCC (4.7% vs 0%, P < 0.001) compared to the NASH-HCC group. A trend of poorer recurrence free survival at 5 years was seen in HCV-HCC patients compared to NASH-HCC who underwent a Liver transplantation (P = 0.11).


CONCLUSIONS
Patients transplanted for NASH-HCC appear to have less aggressive tumour features compared to those with HCV-HCC, which likely in part accounts for their improved recurrence free survival.
Multi-Organ Transplant Program, Department of Surgery, London Health Sciences Centre, Ontario N6A 5A5, Canada. roberto.hernandezalejandro@lhsc.on.ca
Roberto
R
Hernandez-Alejandro
Kris P
KP
Croome
Martin
M
Drage
Nathalie
N
Sela
Jeremy
J
Parfitt
Natasha
N
Chandok
Paul
P
Marotta
Cheryl
C
Dale
William
W
Wall
Douglas
D
Quan
D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D005234:Fatty Liver / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome