title: Liver Transplantation for Hepatocellular Carcinoma in Young Adults: A United Network for Organ Sharing Study.
abstract: OBJECTIVE
  Orthotopic liver transplantation (OLT) is curative for hepatocellular carcinoma (HCC). HCC is typically a disease of older adults (OAs); therefore, characteristics and outcomes of OLT for young adults (YAs) (ages 18-40) are not described. The objective of this study was to assess the characteristics and outcomes of YAs with HCC receiving OLT and compare these to OAs (ages >40 years).
  
  
  METHODS
  YAs with HCC who had OLT from the United Network for Organ Sharing (UNOS) database were included in this study. As a comparison group, OAs with HCC were matched 4:1 to the YA group. Descriptive statistics of demographics, comorbidities, and outcomes were generated. Kaplan-Meier product limit estimates were used to assess patient and graft survival. Conditional logistic regression and Cox proportional hazards frailty models were used to compare the groups.
  
  
  RESULTS
  A total of 464 YAs received OLT for HCC. The most common underlying liver diseases were hepatitis C virus (21.3%), hepatitis B virus (HBV, 15.5%), and autoimmune/cholestatic disease (12.3%). An increased number of YAs received OLT for HCC after implementation of model for end-stage liver disease scoring. One thousand two hundred eighty OAs served as the comparison group. Post-transplant 5-year survival was 73.1% in YAs with a retransplantation rate of 7.8%. In OAs, survival and retransplantation rates were lower (68.6% p = 0.093; 4.3% p = 0.001).
  
  
  CONCLUSIONS
  Four hundred sixty-four YAs with HCC received OLT in the UNOS database. Compared to the older population, survival and retransplantation rates were higher. HBV, which is vaccine preventable, is a frequent contributor to HCC in YAs.
authors.affiliation: 1 Children's Center for Cancer and Blood Disease , Children's Hospital Los Angeles, Los Angeles, California.|2 Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Pediatrics, Keck School of Medicine, University of Southern California , Los Angeles, California.
authors.forename: Stefanie M
authors.initials: SM
authors.lastname: Thomas
authors.affiliation: 1 Children's Center for Cancer and Blood Disease , Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Diana
authors.initials: D
authors.lastname: Moke
authors.affiliation: 3 Department of Quantitative Health Sciences, Cleveland Clinic , Cleveland, Ohio.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: 4 Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's , Cleveland, Ohio.
authors.forename: Rabi
authors.initials: R
authors.lastname: Hanna
authors.affiliation: 5 Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic , Cleveland, Ohio.
authors.forename: Mohammad Nasser
authors.initials: MN
authors.lastname: Kabbany
authors.affiliation: 5 Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic , Cleveland, Ohio.|6 Digestive Disease Institute , Cleveland Clinic, Cleveland, Ohio.
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D016022:Case-Control Studies; D015209:Cholangitis, Sclerosing / Q000150:complications; D002779:Cholestasis / Q000150:complications; D016208:Databases, Factual; D058625:End Stage Liver Disease; D005260:Female; D006085:Graft Survival; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D019693:Hepatitis, Autoimmune / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008105:Liver Cirrhosis, Biliary / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult
keywords: hepatitis B virus; model for end-stage liver disease; surgical oncology