Surgical treatment of breast cancer in liver transplant recipients: a cross-sectional analysis

Abstract

Presenter: David Stillman MD | Albany Medical Center Background: Orthotopic liver transplantation is the gold standard for curative treatment of end-stage liver disease. Since Theodore Starzl performed the first human liver transplant in 1963, outcomes have dramatically improved as understanding of the immune response has grown hand-in-hand with the burgeoning armamentarium of immunosuppressant medications. Increased graft and host survival has drawn the medical community’s attention to the long-term care of this unique patient population, including the relationship between transplantation, immunosuppression, and malignancy. Breast cancer is the most common non-skin cancer in women, and outcomes research investigating the intersection of breast cancer and liver transplant is sparse. Here, we present a cross-sectional study examining outcomes of patients with history of liver transplant who underwent lumpectomy or mastectomy using data queried from the National Inpatient Sample database from 2005 to 2014. Methods: The 99 liver transplant patients who met our criteria were compared to 273,841 breast cancer patients, with both groups having tissue diagnosis of malignancy or carcinoma in situ and having undergone uni- or bilateral mastectomy or lumpectomy, with or without reconstruction. Hospital and patient-level characteristics were compared with student T, Mann-Whitney, and chi squared tests where appropriate, revealing grossly similar populations and facilities. Elixhauser Comorbidity Index scores were calculated to compare degree of comorbidity. Logistic regression models were employed for outcomes investigation. Financial and length of stay data were evaluated with linear regression modeling, adjusted based on Consumer Price Index 2020. Multivariate logistic regressions were used to compare outcomes between hospital settings. Results: Elixhauser Comorbidity Index scores were calculated with a significant difference in scores >10, 20.5% in transplant recipients vs 10.2% in those without (p = 0.001). Logistic regression models showed no statistically significant difference in morbidity between groups with the exception of increased rate of acute renal failure in the transplanted population (9.9% vs 0.6%, p < 0.001). Financial and length of stay data evaluated with linear regression modeling showed significantly higher median total hospital charges in the transplanted cohort ($63,724 vs $43,002; p < 0.001), however multivariate logistic regressions used to compare outcomes between hospital settings showed this difference in cost of care disappeared in transplant and teaching centers. Conclusion: Overall, this study shows that despite the increased complexity of caring for liver transplant recipients with breast cancer, teaching hospitals and transplant centers deliver cost-effective surgical treatment of breast cancer without increased mortality and morbidity compared to the non-transplanted population.