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NASH-Related HCC is Associated with Lower Rates of Post-Transplant HCC Recurrence: A Large Database Analysis

P. J. Altshuler, R. Lamm, K. Patel, H. Dang, O. Shaheen, A. P. Shah, J. Glorioso, C. G. Ramirez, A. M. Frank, W. R. Maley, A. S. Bodzin

Department of Surgery, Thomas Jefferson University, Philadelphia, PA

Meeting: 2021 American Transplant Congress

Abstract number: 85

Keywords: Hepatocellular carcinoma

Topic: Clinical Science » Liver » Liver: Hepatocellular Carcinoma and Other Malignancies

Session Information

Session Name: Liver Transplant Oncology

Session Type: Rapid Fire Oral Abstract

Date: Saturday, June 5, 2021

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:10pm-6:15pm

Location: Virtual

*Purpose: As incidence of hepatocellular carcinoma (HCC) and Non-Alcoholic Steatohepatitis (NASH) increase, NASH-related HCC is an increasingly common transplant indication. Large-scale studies evaluating transplantation for NASH-related HCC are limited, as are studies controlling for metabolic disturbances and systemic comorbidities characteristic of NASH patients. This study attempts to address both, comparing transplantation for NASH-related HCC to non-NASH-related HCC on a national scale.

*Methods: Retrospective analysis of the Organ Procurement and Transplantation Network database identified 1342 NASH and 10,642 non-NASH patients with HCC. After propensity score matching (PSM) to address patient and tumor-related confounders 1175 of each group remained. Primary outcomes assessed were recurrence and recurrence free survival. Additional regression modeling assessed NASH as a predictor of death or recurrence.

*Results: Upon PSM baseline recipient, donor, transplant and tumor characteristics were largely similar between NASH and non-NASH groups. BMI did remain higher in NASH patients (31.7 vs. 28, p<0.01) as did recipient age (65 vs. 64, p=0.02) and incidence of diabetes (72.1% vs. 31.4%, p<0.01). Recipient ethnicity also remained disparate. As demonstrated in Table 1, recurrence at 5 years was lower 5.5% in NASH vs. 8.4% in non-NASH patients (p=0.02). Recurrence-free survival at 5 years was 78.3% in NASH vs. 74.5% in non-NASH patients (p=0.08). Adjusted multivariable regression accounting for factors independently predictive of recurrence at 5 years demonstrated that NASH was protective against recurrence (HR: 0.63, p<0.01).

*Conclusions: In a large-scale propensity matched analysis, HCC in NASH patients appears less likely to experience HCC recurrence at 5 years leading to improved recurrence-free survival. This is supported by NASH itself being a protective factor against cancer recurrence in adjusted regression analysis. While ongoing investigations into the biology of HCC in NASH and non-NASH are essential, this study suggests that HCC in NASH may have improved cancer outcomes after transplant.

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To cite this abstract in AMA style:

Altshuler PJ, Lamm R, Patel K, Dang H, Shaheen O, Shah AP, Glorioso J, Ramirez CG, Frank AM, Maley WR, Bodzin AS. NASH-Related HCC is Associated with Lower Rates of Post-Transplant HCC Recurrence: A Large Database Analysis [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/nash-related-hcc-is-associated-with-lower-rates-of-post-transplant-hcc-recurrence-a-large-database-analysis/. Accessed May 26, 2025.

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