Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
HPB (Oxford). 2022 Apr;24(4):470-477. doi: 10.1016/j.hpb.2021.08.943. Epub 2021 Sep 6.
Nonalcoholic steatohepatitis-associated hepatocellular carcinoma (NASH-HCC) is the second-leading cause of liver transplantation (LT) performed for HCC. Despite this, little is known about the clinical characteristics and outcomes of NASH-HCC.
Patients undergoing LT for HCC from 2001 to 2017 at a single center were reviewed. Outcomes of NASH-HCC (n = 51) were compared to other etiologies of HCC including hepatitis C (HCV) hepatitis B (HBV), and alcoholic liver disease (ALD). Outcomes of NASH-HCC were also compared to HCV in the direct-acting antiviral (DAA) era (2014-2017).
The frequency of NASH-HCC as the primary indication for LT in patients with HCC increased significantly during the study period from 4.4% (2001-2008) to 15.6% in 2017. NASH-HCC patients were significantly older (median age 65 vs. 60; P < 0.001) with significantly lower alpha-fetoprotein levels (7.5 vs. 26.5, P < 0.001) compared to other etiologies. The 1-, 3-, and 5-year overall survival of NASH-HCC was 92%, 86%, and 80%. Overall survival of NASH-HCC was not significantly different compared to HCV, HBV, or ALD. Compared to HCV-HCC in the DAA era (n = 99), NASH-HCC had comparable post-LT survival (3-year survival 87% vs. 86%, P = 0.870).
In this large single-center experience of NASH-HCC, we demonstrate favorable outcomes of NASH-HCC following LT comparable to other common etiologies of HCC.
非酒精性脂肪性肝炎相关肝细胞癌（NASH-HCC）是 HCC 进行肝移植（LT）的第二大原因。尽管如此，人们对 NASH-HCC 的临床特征和结局知之甚少。
回顾了 2001 年至 2017 年在一家中心接受 HCC 肝移植的患者。将 NASH-HCC（n=51）的结果与其他 HCC 病因（包括丙型肝炎[HCV]、乙型肝炎[HBV]和酒精性肝病[ALD]）进行比较。还将 NASH-HCC 的结果与 DAA 时代（2014-2017 年）的 HCV 进行了比较。
在研究期间，NASH-HCC 作为 HCC 患者 LT 的主要指征的频率从 4.4%（2001-2008 年）显著增加到 2017 年的 15.6%。与其他病因相比，NASH-HCC 患者年龄明显更大（中位数年龄 65 岁 vs. 60 岁；P<0.001），甲胎蛋白水平明显更低（7.5 与 26.5，P<0.001）。NASH-HCC 的 1 年、3 年和 5 年总生存率分别为 92%、86%和 80%。NASH-HCC 的总生存率与 HCV、HBV 或 ALD 无显著差异。与 DAA 时代的 HCV-HCC（n=99）相比，NASH-HCC 的 LT 后生存率相当（3 年生存率为 87%对 86%，P=0.870）。
在这项大型单中心 NASH-HCC 经验中，我们证明了 NASH-HCC 在 LT 后的结局良好，与其他常见 HCC 病因相当。
