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Hepatocellular carcinoma (HCC) mostly develops in a cirrhotic liver and represents a serious public health problem. Liver transplantation (LT) is a therapeutic option for HCC that offers to patients a long-term survival. The aim is to investigate depression and anxiety in HCC patients evaluated for LT. Retrospective study (N=179) at liver disease clinic on patients with a diagnosis of cirrhosis evaluated for LT. Inclusion criteria: completion of the psychological evaluation for eligibility to transplantation. The sample was divided in two groups: HCC (89/179; 49.7%) and no-HCC. Patients underwent a psychological evaluation with clinical interviews and psychological assessment with self-report questionnaires for depression (BDI-II), anxiety (BAI) and general psychological problems (SCL-90). Descriptive analyses and linear regression analyses were performed. Among the 179 patients, 84.9% were men, the mean age was 58 years. HCC group has lower depression (p <.01), anxiety (p <.05), SCL-Somatization, SCL-Depression, and SCL-Anxiety (p <.05) than no-HCC group. They also have a lower severty of liver disfunction (MELDNa) (p <.001). Univariate linear regression analysis highlighted a correlation between depression (BDI-II) and respectively: age, gender, HCC, MELDNa class and psychopathological anamnesis. Multivariate linear regression analysis [covariate: male gender OR -3.6 (95% CI -7.11– -0.21); psychopathological anamnesis OR 6.3 (95% CI 3.87 – 8.77), HCC OR -4.3 (95% CI -6.88 – -1.80); p < 0.05] highlighted that depression is positively associated with psychopathological history and inversely with HCC and male gender. Counterintuitively, patients with HCC show less depression/anxiety than patients without HCC, probably because of multiple loco-regional or systemic oncologic therapies. HCC and male gender have a significant effect on depression. HCC patients may not perceive the severity of their liver disease and lack of insights on it, therefore it could be important to enhance their compliance to the transplant programs. [ABSTRACT FROM AUTHOR]

Accurate pre-Liver Transplant(LT) cardiac risk estimation is paramount to guide graft allocation and to improve post-LT outcome. CAR-OLT-score predicts major 1-year post-LT cardiovascular complications(CVD-Com), but external validation is lacking. We aimed to test the performance of the score in identifying cardiac contraindication(Ca-Con) to LT-listing and to validate CAR-OLT-score to predict major 1-year CVD-Com post-LT. We consecutive enrolled all adult cirrhotics who underwent first pre-LT evaluation in Rome-Gemelli-Center(RO-cohort, N=342, from 2015 to 2019) and Turin-Center(TU-cohort, N=302, from 2015 to 2017). The main outcome measures were Ca-Con to listing(after center-specific cardiology work-up) and major 1-year CVD-Com post-transplant(death/hospitalization for CVD event). Discriminative performance of CAR-OLT-score was evaluated by area-under-the-ROC-curve(AUROC) method. Among 644 pre-LT cirrhotics, 23(3.6%) received a Ca-Con to listing (52.2% because of coronary artery disease, CAD). CAD, heart failure and atrial fibrillation were independent predictors of Ca-Con to listing. Among 431 first-LT recipients, 38(8.8%) patients experienced 1-year major CVD-Com (39.5% atrial-fibrillation, 23.7% heart-failure, 21% myocardial infarction). Diabetes, pulmonary hypertension, non-active workers were independent predictors of 1-year major CVD-Com. RO-cohort had higher prevalence of hypertensive, obese, diabetic, alcoholic patients and higher burden of CAD, atrial-fibrillation, heart-failure, peripheral vasculopathy compared with TU-cohort. CAR-OLT-score predicts Ca-Con to listing in RO-cohort (AUROC 0.806) and TU-cohort (AUROC 0.978) and 1-year major CVD-Com in RO-cohort (AUROC 0.746) and TU-cohort (AUROC 0.640). 193(29.9%) candidates had CAR-OLT-score ≤23. This cut-off had 99% NPV for Ca-Con to listing and 95% NPV for 1-year major CVD-Com post-LT. Candidates with CAR-OLT-score ≤23 underwent 18 cardiac-exercise-stress-test, 89 myocardial-perfusion-imaging, 24 dobutamine-stress-echocardiography, 10 coronary-computed-tomography, 17 coronary-angiography pre-listing, with estimated costs of 68.090€. CAR-OLT-score ≤23 identified candidates who can be safely listed without provocative cardiac tests, allowing time and cost savings and we validated CAR-OLT-score as predictor of major 1-year CVD-Com in an Italian cohort of LT recipients. [ABSTRACT FROM AUTHOR]