Impact of body mass index on hepatocellular carcinoma recurrence after liver transplantation through long-term follow-up.

BACKGROUND: Obesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index (BMI) on increased risk of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is still questionable. The purpose of this retrospective study of a large cohort of adult patients transplanted for HCC was to investigate the effect of BMI on the incidence of HCC recurrence and outcome. METHODS: Data from 427 adult recipients transplanted for HCC between 2000 and 2017 were collected. Patients were classified at time of LT according to the World Health Organization BMI classification into 3 groups; group 1: BMI <25 (n=166), group 2: BMI 25-29.9 (n=150) and group 3: BMI ≥30 (n=111). RESULTS: There were no significant changes of mean BMI overtime 26.8±5.0 kg/m2 at time of LT and 28.8±23.1 at 5 years. The recurrence rates of HCC after LT in the three groups were 19%, 16% and 17% respectively. The 5, 10 and 15-year recurrence free survival (RFS) rates were respectively 68.6%, 47.3% and 40.8% in group 1, 73.3%, 66.2% and 49.5% in group 2 and 68.8%, 57.5% and 47.7% in group 3 (log rank P=0.47). CONCLUSIONS: Recipient BMI at time of transplant and during follow-up didn't impact the incidence of HCC recurrence nor long-term patient survival, irrespective to the status of the patients and their tumor characteristic at time of LT. The present study clearly confirms that obesity should not be considered, when selecting patients with HCC to LT, as a predictive factor of recurrence.

Early Versus Late Hepatocellular Carcinoma Recurrence After Transplantation: Predictive Factors, Patterns, and Long-term Outcome.

BACKGROUND: Hepatocellular carcinoma (HCC) is currently the first indication of liver transplantation (LT) in Europe and Asia-Pacific region and the third in the United States. HCC recurrence is the main complication affecting short- and medium-term outcomes after LT. METHODS: A total of 433 consecutive adult recipients transplanted for HCC between 2000 and 2017 (mean age: 57.8 ± 8.5 y; 83.8% were males) with a mean follow-up of 74.6 ± 58.6 months were included. Patients had to meet Milan criteria and, since 2014, alpha-fetoprotein score to be listed. Patients with HCC recurrence were classified into early (≤2 y) and late recurrence (>2 y) and were retrospectively reviewed. RESULTS: Patients who developed recurrence (75 patients, 17%) had more tumors outside Milan and University of California San Francisco criteria, high alpha-fetoprotein score, and microvascular invasion at pathology. Early recurrence developed in 46 patients (61.3%); the overall 5- and 10-year survival rates of these patients from time of LT were 6.7% and 0%, which were significantly lower than those with late recurrence 64.0% and 27.1%, respectively (P < 0.001). The median survival times from the diagnosis of HCC recurrence were 15 and 17 months, respectively, in the 2 groups (P < 0.001). Multivariable Cox regression analysis identified alcoholic cirrhosis as etiology of the underlying liver disease (hazard ratio [HR] = 3.074; P = 0.007), bilobar tumor at time of LT (HR = 2.001; P = 0.037), and a tumor size (>50 mm) in the explant (HR = 1.277; P = 0.045) as independent predictors of early recurrence. CONCLUSIONS: Improving the prediction of early HCC recurrence could optimize patient selection for LT, potential adjuvant therapy with new targeted drugs and hence, improve long-term survival.

Osteoporosis in Chronic Hepatitis C

Background and study aim: Hepatitis C virus infection is a multisystemic disease with many extrahepatic manifestations. Affection of bone matrix density is a common complication of chronic hepatitis and cirrhosis. The pathogenesis of osteoporosis in chronic liver disease is still unknown and is expected to be multifactorial. The aim of this work is to assess the frequency of osteoporosis/osteopenia in patients with chronic hepatitis C virus infection with or without cirrhosis.Patients and methods:This study was carried out on 30 patients with chronic HCV infection without cirrhosis (Group II); 30 patients with chronic HCV infection with compensated cirrhosis (Group III) and 20 age and gender matched healthy controls (Group I). All subjects of the study performed liver function tests; viral markers; liver biopsy; hormonal assay and Bone Mineral density measurement (BMD) by Dual energy X-ray absorptiometry (DEXA).Results : In patients with chronic hepatitis C (group II) the frequency of osteopenia was 11 (36.7); osteoporosis 2 (6.7); total patients with low BMD was 13 (43.3). In cirrhotic patients (group III); the frequency of osteopenia was 13 (43.3); osteoporosis was 3 (10.0); and total patients with low BMD was 16(53.3) vs 1(5.0) in the control group (group I). there was also no significant difference between patients with low BMD and patients with normal BMD as regards age; gender; common risk factors; liver function tests or hormonal levels.Conclusion : Reduced BMD is common chronic HCV-infected patients with and without cirrhosis. HCV infection is a risk factor of osteoporosis