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Mohkam K, Abdallah R, N'kontchou G, Ganne N, Barbier L, Salamé E, Bucur P, Rayar M, Robin F, Boudjema K, Pietrasz D, Cherqui D, Adam R, Lim C, Savier E, Scatton O, Maulat C, Suc B, Muscari F, Laurent A, Duvoux C, Heyd B, Turco C, Doussot A, Merle P, Antonini T, Lesurtel M, Cossé C, Durand F, Soubrane O, Cauchy F, Mabrut JY; ACHBT French research group. Influence of the ABO Blood Group System on Hepatocellular Carcinoma Recurrence After Liver Transplantation. Transplantation 2021. [PMID: 34966104 DOI: 10.1097/TP.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ABO blood group system may influence tumorigenesis, but its prognostic value in liver transplantation (LT) for hepatocellular carcinoma (HCC) has never been assessed. METHODS All consecutive patients who underwent LT for HCC between 2013 and 2017 at 9 centers were analyzed. Predictors of tumor recurrence were identified using multivariable analysis, while comparison between group A and non-A recipients was performed after propensity score matching. RESULTS Among 925 LT recipients, 406 were blood group A, 94 group B, 380 group O, and 45 group AB. On multivariable analysis, group A was associated with tumor recurrence (hazard ratio [HR] = 1.574 [95% confidence interval; 95% CI = 1.034-2.394] P = 0.034). After propensity score matching, 1- and 5-y recurrence rates were 7.4% and 20.1% in group A recipients versus 3.3% and 13.2% in non-A recipients (HR = 1.66 [95% CI = 1.12-2.45], P = 0.011). One and 5-y recurrence-free survivals were 85.2% and 66.8% in group A recipients versus 88.5% and 71.3% in non-A recipients (HR = 1.38 [95% CI = 1.01-1.90], P = 0.045). Among recipients within Milan criteria (n = 604), 1- and 5-y recurrence rates were 5.8% and 12.7% in group A recipients versus 3.1% and 12.2% in non-A recipients (HR = 1.197 [95% CI = 0.721-1.987], P = 0.485). Among recipients outside Milan criteria (n = 182), 1- and 5-y recurrence rates were 12.1% and 43.8% in group A recipients versus 3.9% and 15.6% in non-A recipients (HR = 3.175 [95% CI = 1.526-6.608], P = 0.002). CONCLUSIONS ABO blood system influences the oncological outcome of recipients undergoing LT for HCC. Its incorporation in the prognostication model of LT for HCC may allow improving the management of LT candidates.
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Mourad M, Lebossé F, Merle P, Levrero M, Antonini T, Lesurtel M, Ducerf C, Zoulim F, Mabrut JY, Mohkam K. External validation of the French alpha-fetoprotein model for hepatocellular carcinoma liver transplantation in a recent unicentric cohort - a retrospective study. Transpl Int 2021; 34:535-545. [PMID: 33449394 DOI: 10.1111/tri.13819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/19/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
Prognostic models of liver transplantation (LT) for hepatocellular carcinoma (HCC) mainly derive from LT cohorts with numerous hepatitis C virus (HCV) patients. The AFP model, which is currently used in France to select LT candidates, was derived from a cohort of LT performed between 1988 and 2001, including a majority of HCV-positive recipients. The emergence of new direct-acting antiviral therapies and subsequent decrease of HCV incidence may change the generalizability of such models. We performed an external validation of the AFP model in a cohort of recipients transplanted between 2005 and 2018. Although multivariable analysis identified all three model's factors (AFP level, largest tumor size, number of nodules) as predictors of tumor recurrence, the AFP model showed poor discrimination and calibration in the present cohort. This poor performance could be related to significant differences between the derivation and the present cohort in terms of etiology, severity of underlying liver disease, tumor burden and differentiation, and use of neoadjuvant treatments. The present findings suggest that the decline of HCV-induced HCC among LT candidates may compromise the generalizability of the AFP model in more recent LT cohorts. Further studies are required for updating or building more robust prognostic models.
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Affiliation(s)
- Mohamed Mourad
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,Department of General and Digestive surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Fanny Lebossé
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Philippe Merle
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Massimo Levrero
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Teresa Antonini
- Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Mickaël Lesurtel
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Fabien Zoulim
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Hepatology, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France.,INSERM U1052, Cancer Research Center of Lyon, Lyon, France
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