ABSTRACT
BACKGROUND: Liver transplantation (LT) is a curative treatment option for hepatocellular carcinoma (HCC); recurrent HCC after liver transplantation (HCC-R) is diagnosed in 9%-16%. The objective of this study was to evaluate which factors are associated with R-HCC after liver transplantation. METHODS: This retrospective real-life study analyzed 278 LTs from 3 reference centers (2,093 LTs) in Brazil from 1988 to 2015. HCC-R with histologic confirmation was seen in 40 patients (14.4%). RESULTS: Most of them were male with cirrhosis secondary to viral hepatitis. Only 37.5% underwent chemoembolization, and 50% had cold ischemia time >8 hours. From the explant analysis, most of the patients were outside Milan criteria and 37.5% had microvascular invasion. The donors were mostly male, and the median intensive care unit time was >3 days. The Kaplan-Meier survival was lower according to alpha-fetoprotein (AFP) >200 ng/dL (P = .02), and older donors and more blood transfusions were risk factors for HCC-R death. CONCLUSION: AFP >200 ng/mL was associated with lower survival, and older donors and more blood transfusions were risk factors for death after HCC-R. A trend to lower survival was observed in patients who did not have chemoembolization and had cold ischemia times >8 hours.
Subject(s)
Carcinoma, Hepatocellular/pathology , Cold Ischemia/adverse effects , Liver Neoplasms/pathology , Liver Transplantation/adverse effects , Neoplasm Recurrence, Local/etiology , Adult , Aged , Blood Transfusion/statistics & numerical data , Brazil , Carcinoma, Hepatocellular/surgery , Embolization, Therapeutic , Female , Humans , Kaplan-Meier Estimate , Liver Cirrhosis/surgery , Liver Cirrhosis/virology , Liver Neoplasms/surgery , Male , Middle Aged , Retrospective Studies , Risk Factors , Tissue Donors , alpha-Fetoproteins/analysisABSTRACT
INTRODUCTION: Previous studies have shown that weight gain commonly occurs after liver transplantation (LTx). Few risk factors have been studied. OBJECTIVES: The aim of this study was to assess the weight changes and incidence excessive weight up to 3 years after surgery. METHODS: Post-LTx patients were assessed for their weight changes and incidence of excessive weight before liver disease; on the first outpatient appointment after LTx; 3 and 6 mo after LTx; 1; 2 and 3y after LTx. Demographic, socioeconomic, lifestyle and clinical variables were collected to assess risk factors for weight gain, overweight and obesity using linear and logistic regression analysis. RESULTS: Eighty patients undergoing LTx between 1997/2006 were assessed. Patients lost an average of 9.1 kg during liver disease. This weight was recovered within 1 year after surgery; after 3 years, patients had gained an average of 11.6 kg. The incidence of excessive weight increased over the years, and 56.4% of patients were overweight in the 3 years after LTx; most of them were obese (30.0%). Risk factors for weight gain on the third year after LTx were greater BMI before liver disease (p < 0.01); former smoker (p < 0.01); family history of overweight (p = 0.04); being hosewife/unemployed/retired (p = 0.08); alcoholic indication for LTx (p = 0.02). Risk factors for incidence of excessive weight on the third year after LTx were being married (RR: 13.13; CI: 1.33-125.0); being former smoker (RR: 4.68; CI: 1.16-18.85); greater age at LTx (RR: 1.1; CI: 1.02-1.20). CONCLUSIONS: Post-LTx patients experienced weight gain after surgery, mainly during the 1 year after operation and increased progressive incidence up to 3 years, due to different risk factors, some of them can be prevented.
