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Occult Hepatocellular Carcinoma Associated With Transjugular Intrahepatic Portosystemic Shunts in Liver Transplant Recipients
Author(s) -
Krumeich Lauren N.,
Mancinelli Jenna,
Cucchiara Andy,
Eddinger Kevin,
Aufhauser David,
Goldberg Drew W.,
Siegelman Evan S.,
Rosen Mark,
Reddy K. Rajender,
Hoteit Maarouf,
Furth Emma E.,
Olthoff Kim M.,
Shaked Abraham,
Levine Matthew,
Abt Peter
Publication year - 2021
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.26073
Subject(s) - medicine , hepatocellular carcinoma , occult , gastroenterology , hazard ratio , transjugular intrahepatic portosystemic shunt , liver transplantation , milan criteria , proportional hazards model , portal vein thrombosis , transplantation , radiology , portal hypertension , pathology , thrombosis , cirrhosis , confidence interval , alternative medicine
Transplant eligibility for hepatocellular carcinoma (HCC) is determined by the imaging identification of tumor burden within the Milan criteria. Transjugular intrahepatic portosystemic shunt(s) (TIPS) reduce portal hypertension but may impact HCC visualization. It was hypothesized that the presence of pretransplant TIPS would correlate with occult HCC and reduced survival. A single‐center, retrospective, case control study was performed among liver transplant recipients with HCC (2000‐2017). The primary endpoint was occult disease on explant pathology. Backward stepwise logistic regression was performed. The secondary endpoints disease‐free survival (DFS) and overall survival (OS) were evaluated with Kaplan‐Meier curves and Cox regression analysis. Of 640 patients, 40 had TIPS and more frequently exhibited occult disease (80.0% versus 43.1%; P < 0.001; odds ratio [OR], 4.16; P < 0.001). Portal vein thrombosis (PVT) similarly correlated with occult disease (OR, 1.97; P = 0.02). Explant tumor burden was equivalent between TIPS subgroups; accordingly, TIPS status was not independently associated with reduced DFS or OS. However, exceeding the Milan criteria was associated with reduced DFS (hazard ratio, 3.21; P = 0.001), and TIPS status in patients with a single suspected lesion (n = 316) independently correlated with explant tumor burdens beyond these criteria (OR, 13.47; P = 0.001). TIPS on pretransplant imaging are associated with occult HCC on explant pathology. Comparable occult disease findings in patients with PVT suggest that the mechanism may involve altered hepatic perfusion, obscuring imaging diagnosis. TIPS are not independently associated with reduced DFS or OS but are associated with exceeding the Milan criteria for patients with a single suspected lesion. The presence of TIPS may necessitate a higher index of suspicion for occult HCC.