Liver transplant for hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease versus other etiologies: A meta-analysis

Alessandro Parente; Flavio Milana; Shahin Hajibandeh; Shahab Hajibandeh; Krishna V Menon; Ki-Hun Kim; A M James Shapiro; Andrea Schlegel

doi:10.1016/j.dld.2024.09.025

Liver transplant for hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease versus other etiologies: A meta-analysis

Dig Liver Dis. 2024 Oct 28:S1590-8658(24)01044-2. doi: 10.1016/j.dld.2024.09.025. Online ahead of print.

Authors

Alessandro Parente¹, Flavio Milana², Shahin Hajibandeh³, Shahab Hajibandeh⁴, Krishna V Menon⁵, Ki-Hun Kim⁶, A M James Shapiro⁷, Andrea Schlegel⁸

Affiliations

¹ Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, SE59RS, London, United Kingdom; Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, T6G 2R3, Alberta, Canada; Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea. Electronic address: aleparen@gmail.com.
² Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
³ Department of Hepatobiliary and Pancreatic Surgery, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, ST46QG, Stoke-on-Trent, United Kingdom.
⁴ Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, CF144XW, Cardiff, United Kingdom.
⁵ Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, SE59RS, London, United Kingdom.
⁶ Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
⁷ Division of Transplantation Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, T6G 2R3, Alberta, Canada.
⁸ Transplantation Center, Digestive Disease and Surgery Institute, Department of Immunity and Inflammation, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA.

PMID: 39472175
DOI: 10.1016/j.dld.2024.09.025

Abstract

Background & aims: Liver transplantation for hepatocellular carcinoma (HCC) in metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly being diagnosed and predicted to rise further. We compared outcomes of transplantation for MASLD-related HCC versus other etiologies (OE).

Methods: Databases were searched to identify studies comparing outcomes after transplantation MASLD-related HCC with OE-related HCC. Study data were pooled using random-effects modelling. Survival outcomes were analyzed using hazard ratio (HR) for overall survival (OS) and odds ratio (OR) for 1-,3-, and 5-years OS and disease-free survival (DFS).

Results: Ten retrospective comparative studies were identified including a total number of 51'761 patients (MASLD-related HCC=6'793, OE-related HCC=44'968). There were no significant differences in time-to-even survival (HR:0.93, CI_{95 %} 0.81-1.07,p = 0.29), 1-year (87.6% vs 88 %;OR:1.15; CI_{95 %}0.73-1.79,p = 0.55), 3-year (77.2% vs 76 %;OR:1.36;CI_{95 %}0.96-1.94,p = 0.08), or 5-year (67.7% vs 66.3 %;OR:1.08; CI_{95 %}0.77-1.53,p = 0.65) OS rates between the groups. DFS was comparable at 1-year (87.9% vs. 87 %; OR:1.07,p = 0.62), 3-years (77.6% vs. 73.6 %;OR:1.66,p = 0.13) and 5-year (68% vs. 65.6 %;OR:1.37,p = 0.39).

Conclusion: This meta-analysis of the best available evidence (Level 2a) demonstrated that liver transplantation for MASLD-related and OE-related HCC has comparable survival outcomes. Given the global rise in MASLD-related HCC as indication for transplantation, larger studies from other continents, including Europe and Asia, are needed to confirm our findings.

Keywords: Hepatocellular carcinoma; Liver; Metabolic dysfunction-associated fatty liver disease; Metabolic dysfunction-associated steatotic liver disease; Metabolic liver disease; Transplantation.

Publication types

Review