Liver transplantation and hepatocellular carcinoma: is TIPS deleterious? A multicentric retrospective study of the ARCHET research group with propensity score matching.
Cirrhosis
Hepatocellular carcinoma
Liver
Liver transplantation
Survival
TIPS
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
13 Apr 2023
13 Apr 2023
Historique:
received:
16
12
2021
accepted:
30
03
2023
medline:
17
4
2023
entrez:
13
4
2023
pubmed:
14
4
2023
Statut:
epublish
Résumé
A transjugular intrahepatic portosystemic shunt (TIPS) before the liver transplantation (LT) has been considered a contraindication in cases of hepatocellular carcinoma (HCC) because of the risk of tumour growth. We aimed to assess the impact of TIPS on incidental HCC and oncological outcomes in transplanted patients with pre-existing HCC. All consecutive transplanted patients for cirrhosis who had a previous TIPS with or without HCC were included. Between 2007 and 2014, 1912 patients were transplanted. We included 122 (6.3%) patients having TIPS before LT. A 1:3 matched cohort of 366 patients (18.9%) having LT without previous TIPS was selected using a propensity score. Incidental HCC rate and risk factor of HCC recurrence were evaluated using multivariate analysis with a competing risk model. Before LT, in the TIPS group, 27 (22.1%) had an HCC vs. 81 (22.1%) in the control group (p = 1). The incidental HCC rate was similar: 10.5% (10/95) in the TIPS group vs. 6.3% (18/285) in the control group (p = 0.17). Recurrence occurred in 1/27 (3.7%) patient in the TIPS group and in 7/81 (8.6%) patients in the control group, without significant difference (p = 0.51). After multivariate regression, patient's gender (p < 0.01) was significantly associated with HCC recurrence while a tumour within Milan criteria (p = 0.01, sHR: 0.17 [0.04; 0.7]) and an incidental HCC (p<0.01) were found to be protector factors against HCC recurrence. TIPS did not worsen the prognosis of transplanted patients for HCC. TIPS should no longer be contraindicated for oncological reasons in patients with HCC waiting for an LT.
Identifiants
pubmed: 37052722
doi: 10.1007/s00423-023-02875-8
pii: 10.1007/s00423-023-02875-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
149Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Fattovich G, Stroffolini T, Zagni I, Donato F (2004) Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 127:S35–S50. https://doi.org/10.1053/j.gastro.2004.09.014
doi: 10.1053/j.gastro.2004.09.014
pubmed: 15508101
García-Pagán JC, Caca K, Bureau C et al (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med. 362:2370–2379. https://doi.org/10.1056/nejmoa0910102
doi: 10.1056/nejmoa0910102
pubmed: 20573925
Copelan A, Kapoor B, Sands M (2014) Transjugular intrahepatic portosystemic shunt: indications, contraindications, and patient work-up. Semin Intervent Radiol 31:235–242. https://doi.org/10.1055/s-0034-1382790
doi: 10.1055/s-0034-1382790
pubmed: 25177083
pmcid: 4139433
Boyer TD (2012) Chapter 16 - Transjugular Intrahepatic portosystemic shunt (TIPS), Zakim and Boyer's Hepatology (Sixth edition), WB Saunders, pp 255–264
Bañares R, Núñez O, Escudero M et al (2005) Patients with cirrhosis and bare-stent TIPS may have increased risk of hepatocellular carcinoma. Hepatology 41:566–571. https://doi.org/10.1002/hep.20576
doi: 10.1002/hep.20576
pubmed: 15726654
Patel NH, Sasadeusz KJ, Seshadri R et al (2001) Increase in hepatic arterial blood flow after transjugular intrahepatic portosystemic shunt creation and its potential predictive value of postprocedural encephalopathy and mortality. J Vasc Interv Radiol 12:1279–1284. https://doi.org/10.1016/s1051-0443(07)61552-8
doi: 10.1016/s1051-0443(07)61552-8
pubmed: 11698626
Donato MT, Ponsoda X, O’Connor E et al (2008) Role of endogenous nitric oxide in liver-specific functions and survival of cultured rat hepatocytes. Xenobiotica 31:249–264. https://doi.org/10.1080/00498250110052111
doi: 10.1080/00498250110052111
Delhaye M, Moine O, Degraef C et al (2001) Prognostic value of hepatocyte proliferative activity after transjugular intrahepatic portosystemic shunt. Am J Gastroenterol 96:1866–1871. https://doi.org/10.1111/j.1572-0241.2001.03885.x
doi: 10.1111/j.1572-0241.2001.03885.x
pubmed: 11419841
Sanyal AJ, Mirshahi F (1999) Endothelial cells lining transjugular intrahepatic portasystemic shunts originate in hepatic sinusoids: implications for pseudointimal hyperplasia. Hepatology 29:710–718. https://doi.org/10.1002/hep.510290323
doi: 10.1002/hep.510290323
pubmed: 10051472
Bissell DM, Roulot D, George J (2001) Transforming growth factor β and the liver. Hepatology 34:859–867. https://doi.org/10.1053/jhep.2001.28457
doi: 10.1053/jhep.2001.28457
pubmed: 11679955
Libbrecht L, Maleux G, Verslype C et al (2005) Influence of tips on development of hepatocellular carcinoma in cirrhosis. Hepatology 42:236–236. https://doi.org/10.1002/hep.20745
doi: 10.1002/hep.20745
pubmed: 15892064
Santis AD, Iegri C, Kondili L et al (2014) Hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt: a retrospective case–control study. Dig Liver Dis 46:726–730. https://doi.org/10.1016/j.dld.2014.04.009
doi: 10.1016/j.dld.2014.04.009
pubmed: 24893685
Borentain P, Garcia S, Gregoire E et al (2015) Transjugular intrahepatic porto-systemic shunt is a risk factor for liver dysplasia but not hepatocellular carcinoma: a retrospective study of explanted livers. Dig Liver Dis 47:57–61. https://doi.org/10.1016/j.dld.2014.09.009
doi: 10.1016/j.dld.2014.09.009
pubmed: 25308609
Krumeich LN, Mancinelli J, Cucchiara A et al (2021) Occult hepatocellular carcinoma associated with transjugular intrahepatic portosystemic shunts in liver transplant recipients. Liver Transpl 27:1248–1261. https://doi.org/10.1002/lt.26073
doi: 10.1002/lt.26073
pubmed: 33853207
pmcid: 8429178
Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. J Hepatol 35:421–430. https://doi.org/10.1016/s0168-8278(01)00130-1
doi: 10.1016/s0168-8278(01)00130-1
pubmed: 11592607
Bruix J, Sherman M, Diseases PGC American Association for the Study of Liver (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236. https://doi.org/10.1002/hep.20933
doi: 10.1002/hep.20933
pubmed: 16250051
European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer (2012) EASL–EORTC Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943. https://doi.org/10.1016/j.jhep.2011.12.001
doi: 10.1016/j.jhep.2011.12.001
Duvoux C, Roudot-Thoraval F, Decaens T et al (2012) Liver transplantation for hepatocellular carcinoma: a model including α-fetoprotein improves the performance of Milan criteria. Gastroenterology 143:986–994.e3. https://doi.org/10.1053/j.gastro.2012.05.052
Quaglia A, Jutand M, Dhillon A et al (2005) Classification tool for the systematic histological assessment of hepatocellular carcinoma, macroregenerative nodules, and dysplastic nodules in cirrhotic liver. World J Gastroenterol 11:6262–6268. https://doi.org/10.3748/wjg.v11.i40.6262
doi: 10.3748/wjg.v11.i40.6262
pubmed: 16419153
pmcid: 4320328
Kamath PS, Kim WR, Group ALDS (2007) The model for end-stage liver disease (MELD). Hepatology 45:797–805. https://doi.org/10.1002/hep.21563
doi: 10.1002/hep.21563
pubmed: 17326206
Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–700. https://doi.org/10.1056/nejm199603143341104
doi: 10.1056/nejm199603143341104
pubmed: 8594428
Sandri GBL, Lai Q, Lucatelli P et al (2013) Transjugular intrahepatic portosystemic shunt for a wait list patient is not a contraindication for orthotopic liver transplant outcomes. Exp Clin Transplant 11:426–428. https://doi.org/10.6002/ect.2013.0013
doi: 10.6002/ect.2013.0013
Moreno A, Meneu JC, Moreno E et al (2003) Liver transplantation and transjugular intrahepatic portosystemic shunt. Transplant Proc 35:1869–1870. https://doi.org/10.1016/s0041-1345(03)00685-7
doi: 10.1016/s0041-1345(03)00685-7
pubmed: 12962829
Valdivieso A, Ventoso A, Gastaca M et al (2012) Does the transjugular intrahepatic portosystemic influence the outcome of liver transplantation? Transplant Proc 44:1505–1507. https://doi.org/10.1016/j.transproceed.2012.05.070
doi: 10.1016/j.transproceed.2012.05.070
pubmed: 22841197
Sellers CM, Nezami N, Schilsky ML, Kim HS (2019) Transjugular intrahepatic portosystemic shunt as a bridge to liver transplant: current state and future directions. Transplant Rev 33:64–71. https://doi.org/10.1016/j.trre.2018.10.004
doi: 10.1016/j.trre.2018.10.004
Barbier L, Hardwigsen J, Borentain P et al (2014) Impact of transjugular intrahepatic portosystemic shunting on liver transplantation: 12-year single-center experience. Clin Res Hepatol Gastroenterol 38:155–163. https://doi.org/10.1016/j.clinre.2013.09.003
doi: 10.1016/j.clinre.2013.09.003
pubmed: 24183545
Tripathi D, Therapondos G, Redhead DN et al (2002) Transjugular intrahepatic portosystemic stent-shunt and its effects on orthotopic liver transplantation. Eur J Gastroenterol Hepatol 14:827–832. https://doi.org/10.1097/00042737-200208000-00003
doi: 10.1097/00042737-200208000-00003
pubmed: 12172401
Chen B, Pang L, Chen H-B et al (2019) TIPS is not associated with a higher risk of developing HCC in cirrhotic patients: a systematic review and meta-analysis. J Clin Transl Hepatol 7:232–237. https://doi.org/10.14218/jcth.2019.00007
doi: 10.14218/jcth.2019.00007
pubmed: 31608215
pmcid: 6783677
Larrey E, Cluzel P, Rudler M et al (2021) TIPS for patients with early HCC: a bridge to liver transplantation. Clin Res Hepatol Gastroenterol 46:101790. https://doi.org/10.1016/j.clinre.2021.101790
doi: 10.1016/j.clinre.2021.101790
pubmed: 34400368
Zhou K, Hanlon CL, Zhou S et al (2021) No foul play for transjugular intrahepatic portosystemic shunts in liver transplantation for hepatocellular carcinoma. Liver Transpl 27:1680–1681. https://doi.org/10.1002/lt.26202
doi: 10.1002/lt.26202
pubmed: 34115432
Marschner CA, Geyer T, Froelich MF et al (2021) Diagnostic value of contrast-enhanced ultrasound for evaluation of transjugular intrahepatic portosystemic shunt perfusion. Diagnostics 11:1593. https://doi.org/10.3390/diagnostics11091593
doi: 10.3390/diagnostics11091593
pubmed: 34573935
pmcid: 8472159
Chang J, Dumitrache A, Böhling N et al (2020) Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS). Sci Rep 10:20682. https://doi.org/10.1038/s41598-020-77801-9
doi: 10.1038/s41598-020-77801-9
pubmed: 33244180
pmcid: 7692482
Mazzaferro V, Sposito C, Zhou J et al (2018) Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma. Gastroenterology 154:128–139. https://doi.org/10.1053/j.gastro.2017.09.025
doi: 10.1053/j.gastro.2017.09.025
pubmed: 28989060
Koch C, Bette T, Waidmann O et al (2020) AFP ratio predicts HCC recurrence after liver transplantation. PloS One 15:e0235576. https://doi.org/10.1371/journal.pone.0235576
doi: 10.1371/journal.pone.0235576
pubmed: 32614912
pmcid: 7332004
Chaiteerakij R, Zhang X, Addissie BD et al (2015) Combinations of biomarkers and Milan criteria for predicting hepatocellular carcinoma recurrence after liver transplantation. Liver Transpl 21:599–606. https://doi.org/10.1002/lt.24117
doi: 10.1002/lt.24117
pubmed: 25789635
pmcid: 4490162
León RR, Rodríguez ES, Ortega AM et al (2021) Characteristics and outcome of incidental hepatocellular carcinoma after liver transplantation: a cohort study. Rev Esp Enferm Dig 114:219–225. https://doi.org/10.17235/reed.2021.7744/2020
doi: 10.17235/reed.2021.7744/2020
Moghazy WE, Kashkoush S, Meeberg G, Kneteman N (2016) Incidence, characteristics, and prognosis of incidentally discovered hepatocellular carcinoma after liver transplantation. J Transplant 2016:1916387. https://doi.org/10.1155/2016/1916387
doi: 10.1155/2016/1916387
pubmed: 27403337
pmcid: 4925966
Liang T, He Y, Mo S et al (2022) Gender disparity in hepatocellular carcinoma recurrence after curative hepatectomy. Ann Hepatol 27:100695. https://doi.org/10.1016/j.aohep.2022.100695
doi: 10.1016/j.aohep.2022.100695
pubmed: 35257933
Cullaro G, Rubin J, Mehta N et al (2021) Sex-based disparities in hepatocellular carcinoma recurrence after liver transplantation. Transplantation 105:2420–2426. https://doi.org/10.1097/tp.0000000000003575
doi: 10.1097/tp.0000000000003575
pubmed: 33323764
pmcid: 8200371