P-110 POST-TRANSPLANT OUTCOMES IN PATIENTS WITH HEPATOCELLULAR CARCINOMA SUBMITTED TO DOWN-STAGING – BRAZILIAN MULTICENTER STUDY

ISSN: 1665-2681

Annals of Hepatology (AoH) is an international, open access journal published bi-monthly with funds from the Fundación Clínica Médica Sur. It is the official journal of the Mexican Association of Hepatology (AMH), the Latin American Association for the Study of the Liver (ALEH), the Canadian Association for the Study of the Liver (CASL) and the Czech Society of Hepatology (CSH). AoH publishes editorials, opinions, concise reviews, original articles, brief reports, letters to the editor, news from affiliated associations, clinical practice guidelines and summaries of congresses in the field of Hepatology.

Topics covered by AoH include alcoholic liver disease, autoimmune hepatitis, biliary diseases, drug-induced liver injury, genetic liver diseases, NAFLD/NASH and viral hepatitis (HAV, HBV, HCV, HDV, HEV). Our journal seeks to publish articles on basic clinical care and translational research focused on preventing rather than treating the complications of end-stage liver disease.

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Julia Fadini Margon1,2, Aline Lopes Chagas1,2, Angelo A. Mattos3, Márcio Augusto Diniz4, Guilherme Eduardo Gonçalves Felga5, Ilka de Fátima Santana Ferreira Boin6, Rita de Cássia Martins Alves da Silva7, Renato Ferreira da Silva8, José Huygens Parente Garcia9, Agnaldo Soares Lima10, Júlio Cezar Uili Coelho11, Paulo Lisboa Bittencourt12, Venâncio Avancini Ferreira Alves2,13, Luiz Augusto Carneiro D'Albuquerque2,14, Flair José Carrilho1,2, Brazilian HCC Study Group

1 Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo, Brazil

2 São Paulo Clinicas Liver Cancer Group, São Paulo, Brazil

3 Department of Gastroenterology and Hepatology, Fundaçao Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

4 Biostatistics and Bioinformatics Research Center, Cedars Sinai Medical Center, Los Angeles, United States

5 Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

6 Liver Transplantation Unit, State University of Campinas, Brazil

7 Departamento de Clínica Médica e Unidade de Transplante de Fígado, Hospital de Base – Funfarme, Faculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, Brazil

8 Departamento de Cirugía e Unidade de Transplante de Fígado, Hospital de Base – FUNFARME, Facultad de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, Brazil

9 Ceará Unit of Liver Transplantation, Department of Surgery and Liver Transplantation, Federal University of Ceará, Fortaleza, Brazil

10 Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil

11 Federal University of Parana, Surgery Department, Curitiba, Brazil

12 Department of Gastroenterology and Hepatology, Portuguese Hospital of Salvador, Bahia, Brazil

13 Department of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil

14 Digestive Organs Transplant Division. Hospital das Cínicas, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

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Special issue

This article is part of special issue:

Vol. 24. Issue S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Backgrounds

Down-staging (DS) is used to convert hepatocellular carcinoma (HCC) patients outside the criteria for liver transplantation (LT) into patients within the criteria. However, LT after DS remains controversial in the literature.

Aims

Compare the post-LT survival and recurrence risk of HCC patients transplanted after DS with patients transplanted within the Brazilian selection criteria.

Methods

We conducted a multicenter, retrospective cohort study, analyzing medical records of 1,119 liver transplant recipients with HCC in Brazil. HCC treatment prior to LT and whether or not the patient was enrolled after down-staging was analyzed. Survival curves were presented using the Kaplan-Meier and compared using the log-rank test. Univariate and multiple cox regression analysis was fitted.

Results

1,119 patients were included. 81% were males and mean age in the time of LT was 58 ± 8.2 years. In the majority of patients (91%) HCC was the reason for inclusion in transplant list and 8% of patients were listed after successful DS. At HCC diagnosis, 85% of patients were within Milan Criteria. TACE was the most frequent treatment performed. The overall survival (OS) of the entire series was 63% in 5 years, with an average follow-up time of 28 months and post-LT HCC recurrence was 8%. Relapse-free survival and OS, respectively, over 5 years, were 78% and 83% in DS patients and 75% and 89% in patients transplanted within criteria, with no statistical difference in the two analyzes. Evaluation of prognostic factors using simple and multiple Cox Regression did not show that DS was a risk factor for a worse survival or post-LT tumor recurrence.

Conclusions

In our study, patients underwent DS show good post-transplant evolution, similar to those transplanted within criteria, suggesting that response to treatment is a good selection parameter for tumors with favorable tumor biology.

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