Quality of life 10 years after liver transplantation:The impact of graft histology

AIM To evaluate the relationship between the state of transplanted liver graft and the recipient quality of life(QOL) of histologically proven lesions in a 10-year post liver transplantation(LT) cohort of patients. METHODS Seventy-two recipients with a functional first graft at 10 years post-LT underwent liver biopsy and completed a QOL questionnaire. Logistic regression analysis was used to explore associations between histological, clinical andQOL criteria. RESULTS Ten years after LT, fibrosis was detected in 53% of patients, and affected the general health perception, while ductopenia, present in 36%, affected the well-being(P = 0.05). Hepatic steatosis(HS) was present in 33% of patients and was associated with the worst QOL score on multiple domains. When compared to patients without HS, patients with HS had significantly higher incidence of fibrosis(P = 0.03), hepatitis C virus(HCV) infection(P = 0.007), and more patients had retired from their job(P = 0.03). Recurrent or de novo HCV-associated fibrosis and patient retirement as objective variables, and abdominal pain or discomfort and joint aches or pains as subjective variables, emerged as independent determinants of HS. CONCLUSION Long-term liver graft lesions, mainly HS presumably as a surrogate marker of HCV infection, may have a substantial impact on QOL 10 years after LT.

Impact of body mass index on hepatocellular carcinoma recurrence after liver transplantation through long-term follow-up

Background:Obesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index(BMI)on increased risk of hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)is still questionable.The purpose of this retrospective study of a large cohort of adult patients transplanted for HCC was to investigate the effect of BMI on the incidence of HCC recurrence and outcome.Methods:Data from 427 adult recipients transplanted for HCC between 2000 and 2017 were collected.Patients were classified at time of LT according to the World Health Organization BMI classification into 3 groups;group 1:BMI<25(n=166),group 2:BMI 25-29.9(n=150)and group 3:BMI≥30(n=111).Results:There were no significant changes of mean BMI overtime 26.8±5.0 kg/m2 at time of LT and 28.8±23.1 at 5 years.The recurrence rates of HCC after LT in the three groups were 19%,16%and 17%respectively.The 5,10 and 15-year recurrence free survival(RFS)rates were respectively 68.6%,47.3%and 40.8%in group 1,73.3%,66.2%and 49.5%in group 2 and 68.8%,57.5%and 47.7%in group 3(log rank P=0.47).Conclusions:Recipient BMI at time of transplant and during follow-up didn’t impact the incidence of HCC recurrence nor long-term patient survival,irrespective to the status of the patients and their tumor characteristic at time of LT.The present study clearly confirms that obesity should not be considered,when selecting patients with HCC to LT,as a predictive factor of recurrence.