A changing etiologic scenario in liver transplantation for hepatocellular carcinoma in a multicenter cohort study from Latin America - 16/05/18
, Paulo Costa b, Yuri Longatto Boteon c, Sergio Hoyos Duque d, Sebastian Marciano e, Margarita Anders f, Adriana Varón g, Alina Zerega h, Jaime Poniachik i, Alejandro Soza j, Martín Padilla Machaca k, Josemaría Menéndez l, Rodrigo Zapata m, n, Mario Vilatoba o, Linda Muñoz p, Martín Maraschio q, Luis G. Podestá a, Lucas McCormack f, Adrian Gadano e, Ilka S.F. Fatima Boin c, Parente García b, Marcelo Silva aOn behalf of the Latin American Liver Research, Education, Awareness Network (LALREAN)
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Highlights |
• | This multicenter cohort study describes recent trends regarding etiologies of LT for HCC in Latin America. |
• | We observed that there might be a changing figure regarding etiologies of HCC similar to what has been reported in other regions of the world, including a decreasing proportion of HCV and an increasing NAFLD. |
• | However, a high number of HBV related HCC was observed, particularly from Brazil, Argentina and Colombia. |
Summary |
Background and aim |
Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of hepatocellular carcinoma (HCC) and liver transplantation (LT). Our study focused on changing trends of liver related HCC etiologies during the last years in Latin America.
Methods |
From a cohort of 2761 consecutive adult LT patients between 2005 and 2012 in 17 different centers, 435 with HCC were included. Different periods including years 2005–2006, 2007–2008, 2009–2010 and 2011–2012 were considered. Etiology of liver disease was confirmed in the explant.
Results |
Participating LT centers per country included 2 from Brazil (n=191), 5 transplant programs from Argentina (n=98), 2 from Colombia (n=65), 4 from Chile (n=49), 2 from Mexico (n=12), and 1 from Peru (n=11) and Uruguay (n=9). Chronic hepatitis C infection was the leading cause of HCC in the overall cohort (37%), followed by HBV (25%) and alcoholic liver disease (17%). NAFLD and cryptogenic cirrhosis accounted for 6% and 7%, respectively. While HCV decreased from 48% in 2005–06 to 26% in 2011–12, NAFLD increased from 1.8% to 12.8% during the same period, accounting for the third cause of HCC. This represented a 6-fold increase in NAFLD-HCC, whereas HCV had a 2-fold decrease. Patients with NAFLD were older, had lower pre-LT serum AFP values and similar 5-year survival and recurrence rates than non-NAFLD.
Conclusion |
There might be a global changing figure regarding etiologies of HCC in Latin America. This epidemiological change on the incidence of HCC in the world, although it has been reported, should still be confirmed in prospective studies.
Le texte complet de cet article est disponible en PDF.Keywords : Liver cancer, Epidemiology, Transplantation, Steatohepatitis
Abbreviations : AFP, CC, CI, CT, HCC, HR, IQR, LT, MC, MELD, MRI, MVI, NAFL, NAFLD, NASH, PEI, RFA, SHR, TACE, TTR, WL
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