Background: Chronic hepatitis B (HBV) and C (HCV) virus infections are causes of morbidity and mortality in kidney transplant recipients (KTR). Immunosuppressive agents enhance HBV and HCV replication, leading to decreased patient survival due to progressive liver disease, including cirrhosis and hepatocellular carcinoma (HCC). The aim of this study was to assess the incidence and outcome of HCC in KTR.

Methods: We performed a case-control study in patients with chronic HBV and/or HCV infection who underwent kidney transplantation (KT) between 1976 and 2011 and subsequently developed HCC. Patients’ characteristics and outcomes were compared to a control group of HBV and/or HCV positive patients with HCC matched for age and gender who did not have KT.

Results: Among 2944 KTR, 330 had hepatitis B and/or C. Fourteen developed HCC, an incidence of 4.24%. All patients were Caucasian, and 86% were male. Mean age at HCC diagnosis was 52.6 ± 2 years (53.2 ± 1.5 in controls, p = ns). Mean time between transplantation and HCC diagnosis was 16.7 ± 2.7 years. Six HCCs were related to HBV, 6 to HCV, and 2 to co-infection with HBV and HCV. Immunosuppressive therapy was comparable in HBV, HCV and HBV+HCV patients. All patients had corticosteroids. Sixty-four percent of patients received induction treatment and were on triple therapy. At diagnosis, 71% of patients met Milan criteria (65% in the control group, p = ns). Tumour characteristics and treatment modalities including surgical resection, chemoembolization, radiofrequency ablation, or liver transplantation were comparable between the two groups. Patient survival 2 years after HCC diagnosis was 43% in KTR, compared to 76% in the control group (p=0.03). There was no significant difference in overall survival between HBV- and HCV-infected KTR with HCC.

Conclusion: HCC occurs with an incidence of 4.24% in HBV and/or HCV infected patients after KT. Survival after HCC diagnosis is significantly worse compared to a control group of non-transplanted patients with HBV and/or HCV, matched for age and gender, and with similar tumour characteristics.

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