title: Hepatitis C infection and hepatocellular carcinoma in liver transplantation: a 20-year experience.
abstract: BACKGROUND
  Hepatitis C infection (HCV) and hepatocellular carcinoma (HCC), the two main causes of liver transplantation (LT), have reduced survival post-LT. The impact of HCV, HCC and their coexistence on post-LT survival were assessed.
  
  
  METHODS
  All 601 LT patients from 1992 to 2011 were reviewed. Those deceased within 30 days (n = 69) and re-transplants (n = 49) were excluded. Recipients were divided into four groups: (a) HCC-/HCV-(n = 252) (b) HCC+/HCV- (n = 58), (c) HCC-/HCV+ (n = 106) and (d) HCC+/HCV+ (n = 67). Demographics, the donor risk index (DRI), Model for End-Stage Liver Disease (MELD) score, survival, complications and tumour characteristics were collected. Statistical analysis included anova, chi-square, Fisher's exact tests and Cox and Kaplan-Meier for overall survival.
  
  
  RESULTS
  Groups were comparable with regards to baseline characteristics, but HCC patients were older. After adjusting for age, MELD, gender and the donor risk index (DRI), survival was lower in the HCC+/HCV+ group (59.5% at 5 yrs) and the hazard ratio (HR) was 1.90 [95% confidence interval (CI),1.24-2.95, P = 0.003] and 1.45 (95% CI, 0.99-2.12, P = 0.054) for HCC-/HCV+. HCC survival was similar to controls (HR 1.18, 95% CI, 0.71-1.93, P = 0.508). HCC+/HCV- patients exceeded the Milan criteria (50% versus 31%, P < 0.04) and had more micro-vascular invasion (37.5% versus 20.6%, P = 0.042). HCC+/HCV+ versus HCC+/HCV- survival remained lower (HR 1.94, 95% CI, 1.06-3.81, P = 0.041) after correcting for tumour characteristics and treatment.
  
  
  CONCLUSIONS
  HCV patients had lower survival post-LT. HCC alone had no impact on survival. Patient survival decreased in the HCC+/HCV+ group and this appears to be as a consequence of HCV recurrence.
authors.affiliation: McGill University Health Center Multi-Organ Transplant Program and Hepatopancreatobiliary Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Sinziana
authors.initials: S
authors.lastname: Dumitra
authors.forename: Salleh I
authors.initials: SI
authors.lastname: Alabbad
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Barkun
authors.forename: Teodora C
authors.initials: TC
authors.lastname: Dumitra
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Coutsinos
authors.forename: Peter P
authors.initials: PP
authors.lastname: Metrakos
authors.forename: Mazen
authors.initials: M
authors.lastname: Hassanain
authors.forename: Steven
authors.initials: S
authors.lastname: Paraskevas
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.forename: Jean I
authors.initials: JI
authors.lastname: Tchervenkov
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome