Clinical, Epidemiological and Histopathological Aspects in Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation

Document Type : Research Articles


1 Research Unit of Genetics and Molecular Biology (UPGEM),Sao Jose do Rio Preto Medical School (FAMERP), Sao Jose do Rio Preto, Brazil.

2 Department of Surgery and Liver Transplantation, Hospital de Base/ FUNFARME, Sao Jose do Rio Preto Medical School (FAMERP), Sao Jose do Rio Preto, Brazil.


Background: Hepatocellular Carcinoma (HCC) is the primary liver cancer with high incidence and mortality rates.
Currently one of the major etiologies for liver disease, HCC and liver transplantation is nonalcoholic fatty liver disease
(NAFLD). The aim of the present study was to evaluate the epidemiological, histopathological and clinical aspects of
HCC transplant patients, with emphasis on NAFLD etiology. Methods: This study included all HCC patients submitted
to liver transplantation from 2010 to 2016 of the University Reference Center. The analyzed variables were age, gender,
ethnicity, causes that led to liver transplantation, alpha-fetoprotein (AFP) dosage, histological aspects, recurrence,
survival and NAFLD. Results: A total of 60 patients were included in the study being 80% men with a mean age of
58.3 ± 10.6 years. All patients were cirrhotic. The causes that led to the transplantation were the presence of the hepatitis
C virus (HCV) (56.6% of the patients), an association of the virus with alcohol (20%), the presence of the hepatitis B
virus (HBV) (20%), alcoholic liver disease (ALD) (50.9%) and NAFLD (25%). Of the latter, eight were diagnosed
pre-transplantation and seven were NAFLD carriers without a previous diagnosis. Regarding the Edmondson-Steiner
histological classification, 58.5% of the patients were classified as grade ≤ II. Conclusions: There is predominance of
male patients with a mean age of 58.3 years. Degree ≤ II is the most frequent to the Edmondson-Steiner histological
classification in the evaluated casuistic. HCV, ALD and NAFLD is the most common etiological agents found in the
study. The (high) underestimated prevalence of NAFLD in the pre-transplanted patients is due to the fact that all patients
presented cirrhosis, masking NAFLD signals.


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