Time-Dependent Impact of Hepatocellular Carcinoma on Mortality after Liver Transplantation: A National Cohort Study

Abstract

Background: Patients who receive a liver transplant for hepatocellular carcinoma (HCC) are in better physical condition than other liver transplant recipients. However, HCC patients often receive poorer quality livers. Tumour recurrence also has a negative effect on post-transplant outcomes. We compared mortality of HCC and non-HCC recipients in different post-transplant time periods ('epochs') to separate the impact of these different risk factors on short and longer term post-transplant survival. Methods: We identified a population-based cohort of first-time liver transplant recipients (aged = 16 years) between 2008 and 2016 in the UK. We used Cox regression to estimate hazard ratios (HR) comparing post-transplant mortality between HCC and non-HCC patients in three post-transplant epochs: 0 to 90 days, 90 days to 2 years, and 2 to 5 years, with adjustment first for recipient and later also for donor characteristics. Findings: 1 270 HCC and 3 657 non-HCC transplant recipients were included. 5-year post-transplant survival was 74.5% (95%CI 71.2% to 77.5%) in HCC patients and 84.6% (83.0% to 86.1%) in non-HCC patients. With adjustment for recipient characteristics only, mortality was lower but not statistically significantly different in the first 90-days (HR 0.76, 95% CI 0.53-1.09, p=0.11), but HCC recipients had significantly higher 90-day mortality (90 days to 2 years: 1.99, 1.48-2.66, P<0.001; 2 to 5 years 1.77, 1.30-2.42, p<0.001). Further adjustment for donor characteristics had little impact on these results. Interpretation: HCC recipients have poorer 5-year post-transplant survival than non-HCC recipients, most likely because of tumour recurrence. The more frequent use of poorer quality donor organs for HCC does not explain this difference which support the use of poorer quality donor organs for HCC recipients. Funding Statement: National Institute of Health Research. Declaration of Interests: JvdM reports grants from Healthcare Quality Improvement Partnership during the conduct of the study. All other authors declare no competing interests.