Incidental hepatocellular carcinoma after liver transplantation: Prevalence, histopathological features and prognostic impactReport as inadecuate

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Incidental hepatocellular carcinoma iHCC is a histological finding after liver transplantation LT which relevance has been scarcely studied.


to describe the histopathological features of iHCC and to determine its prognostic impact in terms of tumor recurrence and overall survival.


Observational study including 451 consecutive adult LT patients 2000–2013. Patients aged<18, retransplanted or with early postoperative death were excluded. Median follow-up after LT was 58 months. Multiple Cox’s regression was used to assess the prognostic impact of iHCC on tumor recurrence and mortality while controlling for potential confounders.


141 patients had known HCC before LT 31.3%. Among the remaining 310 patients, the prevalence of iHCC was 8.7% n = 27. In the explanted liver, 36.2% of patients with known HCC and 25.9% of patients with iHCC trespassed Milan criteria p = 0.30. Patients with known and iHCC had similar rates of multinodular disease 50.4% vs 55.6%; p = 0.62, macrovascular invasion 6.5% vs 3.7%; p = 0.58, microvascular invasion 12.9% vs 14.8%; p = 0.76 and moderate-poor tumor differentiation 53.9% vs 70.4%; p = 0.09. In the multivariate analysis, iHCC and known HCC had identical recurrence-free survival after controlling for histological features RR = 1.06, 95%CI 0.36–3.14; p = 0.90. Cumulative 5-year overall survival rates were similar between patients with known and iHCC 65% vs 52.8% respectively; log rank p = 0.44, but significantly inferior as compared with patients without HCC 77.8% p = 0.002 and p = 0.007 respectively. Indeed, in the overall cohort, iHCC was an independent predictor of mortality RR = 3.02; 95%CI 1.62–5.65; p = 0.001.


The risk of tumor recurrence after LT is similar in patients with iHCC and known HCC. A close imaging surveillance is strongly recommended for patients awaiting LT in order to detect HCC prior to LT, thus allowing for an adequate selection of candidates, prioritization and indication of bridging therapies.

Author: Pablo Pérez , Manuel Rodríguez-Perálvarez , Lourdes Guerrero, Víctor González, Rafael Sánchez, Macarena Centeno, Antonio Po



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