Elevated red cell distribution width and outcomes in advanced stage HCC at liver transplant

Abstract

Background: Hepatocellular carcinoma (HCC) has an increasing incidence and mortality rate. The current prognostic tools used to assess HCC severity pre-operatively have failed to mitigate the spread. Therefore, there is an urgent need to determine an accurate predictor of HCC prognosis. We hypothesize that elevated red cell distribution width (RDW) can be predictive of advanced HCC stage at time of liver transplantation. Methods: We performed a retrospective cohort study of all consecutive adult orthotopic liver transplant (OLT) patients from January 1, 2012 through December 31, 2016. Only patients who were diagnosed with incidental or pre-operative HCC were studied. Results: Our transplant center performed 389 OLT of which 32.4% recipients were diagnosed with HCC (N = 126). There was a statistically significant correlation between pre-OLT RDW and explant HCC (p = .026). Patients with pre-OLT RDW of >=14.2 were significantly more likely to have HCC present in explant pathology compared with pre-OLT RDW of <14.2 (OR = 3.8; 95% CI 1.28 to 11.05). The results remained statistically significant (p = .049) when pre-OLT treatment type (TACE,RFA, Y90) was taken into consideration, with an odds ratio of 1.448 (95% CI 1.00–2.09). Overall patient survival when correlating pre-OLT RDW with explant HCC was not significant (p = .959). Conclusion: This is the first research that demonstrates a positive correlation between pre-OLT RDW values and HCC outcomes. Our findings are retrospective from a single center, thus limited. Future multicenter collaborations are essential to further validate these conclusions.