title: Hepatocellular Carcinoma in the Setting of Chronic Hepatitis B Virus Infection: Tumor Recurrence and Survival Rates After Liver Transplantation.
abstract: BACKGROUND
  Higher rates of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) in patients with chronic hepatitis B virus (HBV) infection have been reported. This can influence their selection for LT and post-LT monitoring.
  
  
  OBJECTIVE
  The aim of this work was to compare the rates of post-LT HCC recurrence and survival in HBV and non-HBV patients with the use of the United Network for Organ Sharing (UNOS) database.
  
  
  METHODS
  After accessing the UNOS database, we analyzed patients with HCC stage T2 who underwent LT from cadaveric donors on or after August 24, 1998. Propensity score matching based on age, Model for End-Stage Liver Disease (MELD), and donor risk index was used to match HBV-HCC patients to HCC patients with other underlying liver diseases: hepatitis C virus (HCV), alcoholic liver disease (ALD), both HCV + ALD, and nonalcoholic steatohepatitis (NASH). Kaplan-Meier plots and multivariable analysis (with the use of propensity score, age, sex, and race) were used to assess post-LT HCC recurrence and overall survival.
  
  
  RESULTS
  A total of 4,480 HCC patients were matched. Their average age was 57 ± 7.8 years and average calculated MELD score was 13. Within 5 years of LT, 5.5% of patients had HCC recurrence and 20% died. HBV-HCC patients had 1.9 and 1.8 times higher hazard of tumor recurrence compared with ALD and NASH patients, respectively, and a 32% lower hazard of death than patients with HCV + ALD. There was no evidence of any other significant difference in HCC recurrence or survival among the etiology groups.
  
  
  CONCLUSIONS
  HCC recurrence and survival rates following LT for HCC patients with chronic HBV infection are similar to those of HCC patients with other underlying liver diseases. These findings support LT as a viable option for HCC-HBV patients.
authors: Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: mdugum.md@gmail.com.
authors: M
authors: M
authors: Dugum
authors: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: I
authors: I
authors: Hanouneh
authors: Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors: R
authors: R
authors: Lopez
authors: Transplantation Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: F
authors: F
authors: Aucejo
authors: Transplantation Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: B
authors: B
authors: Eghtesad
authors: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors: N
authors: N
authors: Zein
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000601:surgery / Q000821:virology; D058625:End Stage Liver Disease / Q000601:surgery* / Q000821:virology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery; D015996:Survival Rate