Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2024

Open Access 01-12-2024 | Hepatocellular Carcinoma | Research

Does depressurization of the portal vein before liver transplantation affect the recurrence of HCC? A nested case-control study

Authors: Guo Wei, Yong Zhao, Shifeng Feng, Jingsheng Yuan, Gang Xu, Tao Lv, Jian Yang, Lingxiang Kong, Jiayin Yang

Published in: BMC Cancer | Issue 1/2024

Login to get access

Abstract

Background

Portal hypertension (PHT) has been proven to be closely related to the development of hepatocellular carcinoma (HCC). Whether PHT before liver transplantation (LT) will affect the recurrence of HCC is not clear.

Methods

110 patients with depressurization of the portal vein (DPV) operations (Transjugular Intrahepatic Portosystemic Shunt—TIPS, surgical portosystemic shunt or/and splenectomy) before LT from a HCC LT cohort, matched with 330 preoperative non-DPV patients; this constituted a nested case-control study. Subgroup analysis was based on the order of DPV before or after the occurrence of HCC.

Results

The incidence of acute kidney injury and intra-abdominal bleeding after LT in the DPV group was significantly higher than that in non-DPV group. The 5-year survival rates in the DPV and non-DPV group were 83.4% and 82.7% respectively (P = 0.930). In subgroup analysis, patients in the DPV prior to HCC subgroup may have a lower recurrence rate (4.7% vs.16.8%, P = 0.045) and a higher tumor free survival rate (88.9% vs.74.4%, P = 0.044) after LT under the up-to-date TNMI–II stage, while in TNM III stage, there was no difference for DPV prior to HCC subgroup compared with the DPV after HCC subgroup or the non-DPV group.

Conclusion

Compared with DPV after HCC, DPV treatment before HCC can reduce the recurrence rate of HCC after early transplantation (TNM I-II). DPV before LT can reduce the recurrence of early HCC.
Appendix
Available only for authorised users
Literature
1.
Mehta N, Bhangui P, Yao FY, Mazzaferro V, Toso C, Akamatsu N, et al. Liver transplantation for hepatocellular carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference. Transplantation. 2020;104(6):1136–42.PubMedCrossRef
2.
de’Angelis N, Landi F, Carra MC, Azoulay D. Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review. World J Gastroenterol. 2015;21(39):11185–98.PubMedPubMedCentralCrossRef
3.
Lee EW, Shahrouki P, Alanis L, Ding P, Kee ST. Management options for gastric variceal hemorrhage. JAMA Surg. 2019;154(6):540–8.PubMedCrossRef
4.
Rajwani K, Fortune BE, Brown RS, Jr. Critical care management of gastrointestinal bleeding and ascites in liver failure. Semin Respir Crit Care Med. 2018;39(5):566–77.PubMedCrossRef
5.
Yoshiji H, Nagoshi S, Akahane T, Asaoka Y, Ueno Y, Ogawa K, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2020. J Gastroenterol. 2021;56(7):593–619.PubMedPubMedCentralCrossRef
6.
Cremers I, Ribeiro S. Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis. Th Adv Gastroenterol. 2014;7(5):206–16.CrossRef
7.
Wong F, Sniderman K, Liu P, Blendis L. The mechanism of the initial natriuresis after transjugular intrahepatic portosystemic shunt. Gastroenterology. 1997;112(3):899–907.PubMedCrossRef
8.
9.
Lesmana CRA, Raharjo M, Gani RA. Managing liver cirrhotic complications: overview of esophageal and gastric varices. Clin Mol Hepatol. 2020;26(4):444–60.PubMedPubMedCentralCrossRef
10.
Sellers CM, Nezami N, Schilsky ML, Kim HS. Transjugular intrahepatic portosystemic shunt as a bridge to liver transplant: current state and future directions. Transplantation Reviews (Orlando Fla). 2019;33(2):64–71.PubMedCrossRef
11.
12.
de Ville J, D’Ambrosio G, Grimaldi C. Surgical management of portal hypertension in children. Semin Pediatr Surg. 2012;21(3):219–32.CrossRef
13.
14.
Yoshizumi T, Itoh S, Shimokawa M, Inokuchi S, Harada N, Takeishi K, et al. Simultaneous splenectomy improves outcomes after adult living donor liver transplantation. J Hepatol. 2021;74(2):372–9.PubMedCrossRef
15.
Singal AG, Zhang E, Narasimman M, Rich NE, Waljee AK, Hoshida Y, et al. HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: a meta-analysis. J Hepatol. 2022;77(1):128–39.PubMedPubMedCentralCrossRef
16.
Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127(5 Suppl 1):S35–50.PubMedCrossRef
17.
Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol. 2009;50(5):923–8.PubMedPubMedCentralCrossRef
18.
Kim R, Jeong WK, Kang TW, Song KD, Lee MW, Ahn SH et al. Intrahepatic distant recurrence after radiofrequency ablation of hepatocellular carcinoma: relationship with portal hypertension. Acta radiologica (Stockholm, Sweden: 1987). 2019;60(12):1609-18.
19.
Mancuso A, Perricone G. Hepatocellular carcinoma and liver transplantation: state of the art. J Clin Translational Hepatol. 2014;2(3):176–81.
20.
Gundlach JP, Ellrichmann M, van Rosmalen M, Vogelaar S, Eimer C, Rheinbay C, et al. Liver transplantation for HCC in cirrhosis: are Milan criteria outdated? Z Gastroenterol. 2024;62(1):43–9.PubMedPubMedCentralCrossRef
21.
Mazzaferro V, Sposito C, Zhou J, Pinna AD, De Carlis L, Fan J, et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma. Gastroenterology. 2018;154(1):128–39.PubMedCrossRef
22.
Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G. STROCSS 2019 guideline: strengthening the reporting of cohort studies in surgery. Int J Surg. 2019;72:156–65.PubMedCrossRef
23.
Amin MBGD. AJCC cancer staging manual. 8th ed. New York, NY: Springer; 2017.
24.
Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the international club of ascites. J Hepatol. 2015;62(4):968–74.PubMedCrossRef
25.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.PubMedPubMedCentralCrossRef
26.
27.
Tabrizian P, Holzner ML, Mehta N, Halazun K, Agopian VG, Yao F, et al. Ten-year outcomes of liver transplant and downstaging for hepatocellular carcinoma. JAMA Surg. 2022;157(9):779–88.PubMedPubMedCentral
28.
Thabut D, Kudo M. Treatment of portal hypertension in patients with HCC in the era of Baveno VII. J Hepatol. 2023;78(3):658–62.PubMedCrossRef
29.
Jung KS, Kim JH, Kim SU, Song K, Kim BK, Park JY, et al. Liver stiffness value-based risk estimation of late recurrence after curative resection of hepatocellular carcinoma: development and validation of a predictive model. PLoS ONE. 2014;9(6):e99167–e.PubMedPubMedCentralCrossRef
30.
Berzigotti A, Reig M, Abraldes JG, Bosch J, Bruix J. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology (Baltimore MD). 2015;61(2):526–36.PubMedCrossRef
31.
Liu Z, Liu Y, Zhang W, Hong Y, Meng J, Wang J, et al. Deep learning for prediction of hepatocellular carcinoma recurrence after resection or liver transplantation: a discovery and validation study. Hepatol Int. 2022;16(3):577–89.PubMedCrossRef
32.
Vauthey J-N, Ribero D, Abdalla EK, Jonas S, Bharat A, Schumacher G, et al. Outcomes of liver transplantation in 490 patients with hepatocellular carcinoma: validation of a uniform staging after surgical treatment. J Am Coll Surg. 2007;204(5):1016–28.PubMedCrossRef
33.
Bañares R, Núñez O, Escudero M, Fernández C, Vaquero J, Beceiro I, et al. Patients with cirrhosis and bare-stent TIPS may have increased risk of hepatocellular carcinoma. Hepatology (Baltimore MD). 2005;41(3):566–71.PubMedCrossRef
34.
Fichtl A, Seufferlein T, Zizer E. Risks and benefits of TIPS in HCC and other liver malignancies: a literature review. BMC Gastroenterol. 2023;23(1):403.PubMedPubMedCentralCrossRef
35.
Wallace M, Swaim M. Transjugular intrahepatic portosystemic shunts through hepatic neoplasms. J Vascular Interventional Radiology: JVIR. 2003;14(4):501–7.PubMedCrossRef
36.
Bettinger D, Knüppel E, Euringer W, Spangenberg HC, Rössle M, Thimme R, et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPSS) in 40 patients with hepatocellular carcinoma. Aliment Pharmacol Ther. 2015;41(1):126–36.PubMedCrossRef
37.
Luo S-H, Chu J-G, Huang H, Yao K-C. Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma. World J Clin Cases. 2019;7(13):1599–610.PubMedPubMedCentralCrossRef
38.
Bjørneboe M, Andersen JR, Christensen U, Skinhøj P, Jensen OM. Does a portal-systemic shunt increase the risk of primary hepatic carcinoma in cirrhosis of the liver? Scand J Gastroenterol. 1985;20(1):59–64.PubMedCrossRef
39.
Libbrecht L, Maleux G, Verslype C, Nevens F, Roskams T. Influence of TIPS on development of hepatocellular carcinoma in cirrhosis. Hepatology (Baltimore MD). 2005;42(1):236–7.PubMedCrossRef
40.
Cazals-Hatem D, Vilgrain V, Genin P, Denninger M-H, Durand F, Belghiti J, et al. Arterial and portal circulation and parenchymal changes in Budd-Chiari syndrome: a study in 17 explanted livers. Hepatology (Baltimore MD). 2003;37(3):510–9.PubMedCrossRef
41.
De Santis A, Iegri C, Kondili L, Riggio O, Salvatori FM, Catalano C, et al. Hepatocellular carcinoma in cirrhotic patients with transjugular intrahepatic portosystemic shunt: a retrospective case-control study. Dig Liver Disease: Official J Italian Soc Gastroenterol Italian Association Study Liver. 2014;46(8):726–30.CrossRef
42.
Borentain P, Garcia S, Gregoire E, Vidal V, Ananian P, Ressiot E, et al. Transjugular intrahepatic porto-systemic shunt is a risk factor for liver dysplasia but not hepatocellular carcinoma: a retrospective study of explanted livers. Dig Liver Disease: Official J Italian Soc Gastroenterol Italian Association Study Liver. 2015;47(1):57–61.CrossRef
43.
Chen B, Pang L, Chen H-B, Wu D-B, Wang Y-H, Chen E-Q. TIPS is not associated with a higher risk of developing HCC in Cirrhotic patients: a systematic review and meta-analysis. J Clin Translational Hepatol. 2019;7(3):232–7.
44.
Tanaka T, Yamanaka N, Oriyama T, Furukawa K, Okamoto E. Factors regulating tumor pressure in hepatocellular carcinoma and implications for tumor spread. Hepatology. 1997;26(2):283–7.PubMedCrossRef
45.
46.
Allaire M, Rudler M, Thabut D. Portal hypertension and hepatocellular carcinoma: Des liaisons dangereuses?. Liver Int. 2021;41(8):1734–43.
47.
Kong L, Zhou Y, Bu H, Lv T, Shi Y, Yang J. Deletion of interleukin-6 in monocytes/macrophages suppresses the initiation of hepatocellular carcinoma in mice. J Exp Clin Cancer Res. 2016;35(1):131.PubMedPubMedCentralCrossRef
48.
Ma R, Chen J, Liang Y, Lin S, Zhu L, Liang X, et al. Sorafenib: a potential therapeutic drug for hepatic fibrosis and its outcomes. Biomed Pharmacother. 2017;88:459–68.PubMedCrossRef
49.
Kurata N, Ogura Y, Ogiso S, Onishi Y, Kamei H, Kodera Y. Splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis. Hepatobiliary Pancreat Dis Int. 2019;18(4):337–42.PubMedCrossRef
50.
Matsushima H, Fujiki M, Sasaki K, Cywinski JB, D’Amico G, Uso TD, et al. Can pretransplant TIPS be harmful in liver transplantation? A propensity score matching analysis. Surgery. 2020;168(1):33–9.PubMedCrossRef
51.
Tripathi D, Therapondos G, Redhead DN, Madhavan KK, Hayes PC. Transjugular intrahepatic portosystemic stent-shunt and its effects on orthotopic liver transplantation. Eur J Gastroenterol Hepatol. 2002;14(8):827–32.PubMedCrossRef
52.
Barbier L, Hardwigsen J, Borentain P, Biance N, Daghfous A, Louis G, et al. Impact of transjugular intrahepatic portosystemic shunting on liver transplantation: 12-year single-center experience. Clin Res Hepatol Gastroenterol. 2014;38(2):155–63.PubMedCrossRef
53.
Huang J, Millis JM, Mao Y, Millis MA, Sang X, Zhong S. A pilot programme of organ donation after cardiac death in China. Lancet. 2012;379(9818):862–5.PubMedCrossRef
Metadata
Title
Does depressurization of the portal vein before liver transplantation affect the recurrence of HCC? A nested case-control study
Authors
Guo Wei
Yong Zhao
Shifeng Feng
Jingsheng Yuan
Gang Xu
Tao Lv
Jian Yang
Lingxiang Kong
Jiayin Yang
Publication date
01-12-2024

Other articles of this Issue 1/2024

BMC Cancer 1/2024 Go to the issue

Research

Elucidating the role of EPPK1 in lung adenocarcinoma development

Research

Endostar acts as a pneumonitis protectant in patients with locally advanced non-small cell lung cancer receiving concurrent chemoradiotherapy

Research

A real-world cohort study of first-line afatinib in patients with EGFR-mutant advanced non-small cell lung cancer in Vietnam

Research

Long-term outcomes of pelvic exenterations for gynecological malignancies: a single-center retrospective cohort study

Research

Real-world evidence of treatment patterns and survival of metastatic gastric cancer patients in Germany

Research

Regulatory function and mechanism research for m6A modification WTAP via SUCLG2-AS1- miR-17-5p-JAK1 axis in AML
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits