Background

Nonalcoholic steatohepatitis-associated hepatocellular carcinoma (NASH-HCC) is the second-leading cause of liver transplantation (LT) performed for HCC. Despite this, little is known about the clinical characteristics and outcomes of NASH-HCC.

Methods

Patients undergoing LT for HCC from 2001 to 2017 at a single center were reviewed. Outcomes of NASH-HCC (n = 51) were compared to other etiologies of HCC including hepatitis C (HCV) hepatitis B (HBV), and alcoholic liver disease (ALD). Outcomes of NASH-HCC were also compared to HCV in the direct-acting antiviral (DAA) era (2014–2017).

Results

The frequency of NASH-HCC as the primary indication for LT in patients with HCC increased significantly during the study period from 4.4% (2001–2008) to 15.6% in 2017. NASH-HCC patients were significantly older (median age 65 vs. 60; P < 0.001) with significantly lower alpha-fetoprotein levels (7.5 vs. 26.5, P < 0.001) compared to other etiologies. The 1-, 3-, and 5-year overall survival of NASH-HCC was 92%, 86%, and 80%. Overall survival of NASH-HCC was not significantly different compared to HCV, HBV, or ALD. Compared to HCV-HCC in the DAA era (n = 99), NASH-HCC had comparable post-LT survival (3-year survival 87% vs. 86%, P = 0.870).

Conclusion

In this large single-center experience of NASH-HCC, we demonstrate favorable outcomes of NASH-HCC following LT comparable to other common etiologies of HCC.

中文翻译：

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非酒精性脂肪性肝炎相关肝细胞癌的肝移植结果

背景

非酒精性脂肪性肝炎相关肝细胞癌 (NASH-HCC) 是为 HCC 进行肝移植 (LT) 的第二大原因。尽管如此，人们对 NASH-HCC 的临床特征和结果知之甚少。

方法

回顾了 2001 年至 2017 年在单个中心接受 HCC 肝移植的患者。NASH-HCC (n = 51) 的结果与其他 HCC 病因进行了比较，包括丙型肝炎 (HCV) 乙型肝炎 (HBV) 和酒精性肝病 (ALD)。NASH-HCC 的结果也与直接作用抗病毒 (DAA) 时代 (2014-2017) 的 HCV 进行了比较。

结果

NASH-HCC 作为 HCC 患者 LT 的主要适应症的频率在研究期间从 4.4%（2001-2008 年）显着增加至 2017 年的 15.6%。NASH-HCC 患者年龄显着增加（中位年龄 65 岁 vs. 60 岁） ; P < 0.001) 与其他病因相比，甲胎蛋白水平显着降低（7.5 对 26.5，P < 0.001）。NASH-HCC 的 1 年、3 年和 5 年总生存率为 92%、86% 和 80%。NASH-HCC 的总生存期与 HCV、HBV 或 ALD 相比没有显着差异。与 DAA 时代的 HCV-HCC（n = 99）相比，NASH-HCC 的 LT 后生存率相当（3 年生存率 87% 对 86%，P = 0.870）。

结论

在 NASH-HCC 的大型单中心经验中，我们证明了 LT 后 NASH-HCC 的良好结果与其他常见的 HCC 病因相当。