Time-Dependent Impact of Hepatocellular Carcinoma on Mortality after Liver Transplantation: A National Cohort Study

Background: Patients who receive a liver transplant for hepatocellular carcinoma (HCC) are in better physical condition than other liver transplant recipients. However, HCC patients often receive poorer quality livers. Tumour recurrence also has a negative effect on post-transplant outcomes. We compared mortality of HCC and non-HCC recipients in different post-transplant time periods ('epochs') to separate the impact of these different risk factors on short and longer term post-transplant survival. Methods: We identified a population-based cohort of first-time liver transplant recipients (aged = 16 years) between 2008 and 2016 in the UK. We used Cox regression to estimate hazard ratios (HR) comparing post-transplant mortality between HCC and non-HCC patients in three post-transplant epochs: 0 to 90 days, 90 days to 2 years, and 2 to 5 years, with adjustment first for recipient and later also for donor characteristics. Findings: 1 270 HCC and 3 657 non-HCC transplant recipients were included. 5-year post-transplant survival was 74.5% (95%CI 71.2% to 77.5%) in HCC patients and 84.6% (83.0% to 86.1%) in non-HCC patients. With adjustment for recipient characteristics only, mortality was lower but not statistically significantly different in the first 90-days (HR 0.76, 95% CI 0.53-1.09, p=0.11), but HCC recipients had significantly higher 90-day mortality (90 days to 2 years: 1.99, 1.48-2.66, P