Outcome of hepatitis B and C virus‐associated hepatocellular carcinoma occurring after renal transplantation

Summary Kidney transplant recipients ( KTR ) are subjected to immunosuppressive therapy that can enhance hepatitis B and C virus replication, leading to cirrhosis and hepatocellular carcinoma ( HCC ). The aim of this study was to assess the prevalence and outcome of HCC in KTR . Case‐control study. Patients with chronic HBV and/or HCV infection who underwent kidney transplantation between 1976 and 2011 and subsequently developed HCC were compared to a control group of patients with chronic HBV and/or HCV infection, matched for gender and age at HCC diagnosis, who did not receive kidney transplantation. Among 2944 KTR , 330 had hepatitis B and/or C. Fourteen developed HCC , a period prevalence of 4.2%. Age at HCC diagnosis was 52.6 ± 6.5 years (53.5 ± 5.7 in controls, P =.76). Time between transplantation and HCC diagnosis was 16.7 ± 2.7 years. Six HCC s were related to HBV , six to HCV and two to co‐infection with HBV and HCV . Immunosuppressive therapy was comparable in HBV , HCV and HBV + HCV patients. At diagnosis, 71% of patients met Milan criteria (65% in the control group, P =.4). Alpha‐fetoprotein levels, tumour characteristics and treatment modalities were comparable between both groups. Patient survival 2 years after HCC diagnosis was 28% in KTR , compared to 68% in controls ( P =.024). Survival after HCC diagnosis is significantly worse in KTR compared to nontransplanted patients with HBV and/or HCV . Prevention is crucial and should be based on viral eradication/suppression before or after transplantation.