Abstract
Background: Body composition parameters are reported to influence the risk of hepatocellular carcinoma (HCC) recurrence after liver resection, yet data on patients undergoing liver transplantation are scarce. The aim of this study was to evaluate the impact of the amount of abdominal adipose tissue and skeletal muscles on the risk of HCC recurrence after liver transplantation. Methods: This was a retrospective observational study performed on 77 HCC patients after liver transplantation. Subcutaneous fat area (SFA), visceral fat area, psoas muscle area and total skeletal muscle area were assessed on computed tomography on the level of L3 vertebra and divided by square meters of patient height. The primary outcome measure was five-year recurrence-free survival. Results: Recurrence-free survival in the entire cohort was 95.7%, 90.8%, and 86.5% after one, three, and five years post-transplantation, respectively. SFA was significantly associated with the risk of HCC recurrence (p = 0.013), whereas no significant effects were found for visceral fat and skeletal muscle indices. The optimal cut-off for SFA for prediction of recurrence was 71.5 cm2/m2. Patients with SFA < 71.5 cm2/m2 and ≥71.5 cm2/m2 exhibited five-year recurrence-free survival of 96.0% and 55.4%, respectively (p = 0.001). Conclusions: Excessive amount of subcutaneous adipose tissue is a risk factor for HCC recurrence after liver transplantation and may be considered in patient selection process.
Highlights
Liver transplantation remains the mainstay of treatment for patients with hepatocellular carcinoma (HCC) at low risk of post-transplant tumor recurrence [1]
While a total amount of adipose tissue was significantly associated with the risk of tumor recurrence, these seems to be attributable to the effects of subcutaneous fat given no significant effects of visceral fat area
In a recent study on 78 HCC liver transplant recipients increased visceral fat amount was significantly associated with post-transplant tumor recurrence, whereas no significant effects were found for the amount of subcutaneous adipose tissue [30]
Summary
Liver transplantation remains the mainstay of treatment for patients with hepatocellular carcinoma (HCC) at low risk of post-transplant tumor recurrence [1]. There is a shift towards more precise selection of patients using a combination of morphological criteria with surrogates of tumor biological aggressiveness, such as serum alpha-fetoprotein concentration [3,4,5,6,7,8] Despite these improvements, a remarkable proportion of patients beyond the Milan criteria at increased risk of HCC recurrence remains eligible for transplantation according to recent proposals [9,10]. The aim of this study was to evaluate the impact of the amount of abdominal adipose tissue and skeletal muscles on the risk of HCC recurrence after liver transplantation. Conclusions: Excessive amount of subcutaneous adipose tissue is a risk factor for HCC recurrence after liver transplantation and may be considered in patient selection process
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