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Time-varying Comparison of All-cause Mortality After Liver Transplantation Between Recipients With and Without Hepatocellular Carcinoma: A Population-based Cohort Study Using the United Kingdom Liver Transplant Registry
London Sch Hyg & Trop Med, Dept Med Stat, Keppel St, London WC1E 7HT, England..
London Sch Hyg & Trop Med, Dept Med Stat, Keppel St, London WC1E 7HT, England..ORCID iD: 0000-0003-0894-966X
London Sch Hyg & Trop Med, Dept Med Stat, Keppel St, London WC1E 7HT, England..ORCID iD: 0000-0001-6504-3253
London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London, England..
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2022 (English)In: Transplantation, ISSN 0041-1337, E-ISSN 1534-6080, Vol. 106, no 11, p. E464-E475Article in journal (Refereed) Published
Abstract [en]

Background. Accurately identifying time-varying differences in the hazard of all-cause mortality after liver transplantation (LT) between recipients with and without hepatocellular carcinoma (HCC) may inform patient selection and organ allocation policies as well as post-LT surveillance protocols. Methods. A UK population-based study was carried out using 9586 LT recipients. The time-varying association between HCC and post-LT all-cause mortality was estimated using an adjusted flexible parametric model (FPM) and expressed as hazard ratios (HRs). Differences in this association by transplant year were then investigated. Non-cancer-specific mortality was compared between HCC and non-HCC recipients using an adjusted subdistribution hazard model. Results. The HR comparing HCC recipients with non-HCC recipients was below one immediately after LT (1-mo HR = 0.76; 95% confidence interval [CI], 0.59-0.99; P = 0.044). The HR then increased sharply to a maximum at 1.3 y (HR = 2.07; 95% CI, 1.70-2.52; P < 0.001) before decreasing. The hazard of death was significantly higher in HCC recipients than in non-HCC recipients between 4 mo and 7.4 y post-LT. There were no notable differences in the association between HCC and the post-LT hazard of death by transplant year. The estimated non-cancer-specific subdistribution HR for HCC was 0.93 (95% CI, 0.80-1.09; P = 0.390) and not found to vary over time. Conclusions. FPMs can provide a more precise comparison of post-LT hazards of mortality between HCC and non-HCC patients. The results provide further evidence that some HCC patients have extra-hepatic spread at the time of LT, which has implications for optimal post-LT surveillance protocols.

Place, publisher, year, edition, pages
Ovid Technologies (Wolters Kluwer Health) Wolters Kluwer, 2022. Vol. 106, no 11, p. E464-E475
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Surgery
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URN: urn:nbn:se:uu:diva-488083DOI: 10.1097/TP.0000000000004282ISI: 000871505000001PubMedID: 36017919OAI: oai:DiVA.org:uu-488083DiVA, id: diva2:1709926
Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2024-12-03Bibliographically approved

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Ivanics, Tommy

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