Brief Article
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World J Gastroenterol. Aug 21, 2012; 18(31): 4145-4149
Published online Aug 21, 2012. doi: 10.3748/wjg.v18.i31.4145
A comparison of survival and pathologic features of non-alcoholic steatohepatitis and hepatitis C virus patients with hepatocellular carcinoma
Roberto Hernandez-Alejandro, Kris P Croome, Martin Drage, Nathalie Sela, Jeremy Parfitt, Natasha Chandok, Paul Marotta, Cheryl Dale, William Wall, Douglas Quan
Roberto Hernandez-Alejandro, Kris P Croome, Martin Drage, Nathalie Sela, Natasha Chandok, Paul Marotta, Cheryl Dale, William Wall, Douglas Quan, Multi-Organ Transplant Program, Department of Surgery, London Health Sciences Centre, Ontario N6A 5A5, Canada
Jeremy Parfitt, Department of Pathology, London Health Sciences Centre, Ontario N6A 5A5, Canada
Author contributions: Hernandez-Alejandro R, Croome KP, Marotta P, Quan D, Wall W, Dale C Participated in research design; Hernandez-Alejandro R, Croome KP, Marotta P, Drage M participated in the writing of the paper; Hernandez-Alejandro R, Croome KP, Sela N, Parfitt J and Chandok N participated in the performance of the research; Hernandez-Alejandro R, Croome KP participated in data analysis.
Correspondence to: Roberto Hernandez-Alejandro, MD, Multi-Organ Transplant Program, Department of Surgery, London Health Sciences Centre, 339 Windermere Road London, Ontario N6A 5A5, Canada. roberto.hernandezalejandro@lhsc.on.ca
Telephone: +1-519-6632920 Fax: +1-519-6633858
Received: December 28, 2011
Revised: May 8, 2012
Accepted: May 13, 2012
Published online: August 21, 2012
Abstract

AIM: To compare the clinical outcome and pathologic features of non-alcoholic steatohepatitis (NASH) patients with hepatocellular carcinoma (HCC) and hepatitic C virus (HCV) patients with HCC (another group in which HCC is commonly seen) undergoing liver transplantation.

METHODS: Patients transplanted for HCV and NASH at our institution from January 2000 to April 2011 were analyzed. All explanted liver histology and pre-transplant liver biopsies were examined by two specialist liver histopathologists. Patient demographics, disease free survival, explant liver characteristics and HCC features (tumour number, cumulative tumour size, vascular invasion and differentiation) were compared between HCV and NASH liver transplant recipients.

RESULTS: A total of 102 patients with NASH and 283 patients with HCV were transplanted. The incidence of HCC in NASH transplant recipients was 16.7% (17/102). The incidence of HCC in HCV transplant recipients was 22.6% (64/283). Patients with NASH-HCC were statistically older than HCV-HCC patients (P < 0.001). A significantly higher proportion of HCV-HCC patients had vascular invasion (23.4% vs 6.4%, P = 0.002) and poorly differentiated HCC (4.7% vs 0%, P < 0.001) compared to the NASH-HCC group. A trend of poorer recurrence free survival at 5 years was seen in HCV-HCC patients compared to NASH-HCC who underwent a Liver transplantation (P = 0.11).

CONCLUSION: Patients transplanted for NASH-HCC appear to have less aggressive tumour features compared to those with HCV-HCC, which likely in part accounts for their improved recurrence free survival.

Keywords: Hepatitis C virus, Liver transplant, Hepatocellular carcinoma, Non-alcoholic steatohepatitis, Comparison, Recurrence, Vascular invasion, Poorly differentiated, Survival