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The Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States.

  • Mahale, Parag1
  • Shiels, Meredith S2
  • Lynch, Charles F3
  • Chinnakotla, Srinath4
  • Wong, Linda L5
  • Hernandez, Brenda Y6
  • Pawlish, Karen S7
  • Li, Jie7
  • Alverson, Georgetta8
  • Schymura, Maria J9
  • Engels, Eric A2
  • 1 Division of Cancer Epidemiology and Genetics, National Cancer Institute [email protected]
  • 2 Division of Cancer Epidemiology and Genetics, National Cancer Institute.
  • 3 Department of Epidemiology, University of Iowa.
  • 4 University of Minnesota.
  • 5 Cancer Center, University of Hawaii at Manoa.
  • 6 Department of Epidemiology, University of Hawaii Cancer Center.
  • 7 Cancer Epidemiology Services, New Jersey Department of Health & Senior Services. , (Jersey)
  • 8 Division for Vital Records and Health Statistics Birth/Cancer Sureveillance Section, Michigan Department of Health and Human Services.
  • 9 New York State Department of Health.
Published Article
Cancer Epidemiology Biomarkers & Prevention
American Association for Cancer Research
Publication Date
Nov 16, 2020
DOI: 10.1158/1055-9965.EPI-20-1188
PMID: 33199438


Hepatocellular carcinoma (HCC) carries a poor prognosis. Liver transplantation (LT) is potentially curative for localized HCC. We evaluated the impact of LT on US general population HCC-specific mortality rates. The Transplant Cancer Match Study links the US transplant registry with 17 cancer registries. We calculated age-standardized incidence (1987-2017) and incidence-based mortality (IBM) rates (1991-2017) for adult HCCs. We partitioned population-level IBM rates by cancer stage and calculated counterfactual IBM rates assuming transplanted cases had not received a transplant. Among 129,487 HCC cases, 45.9% had localized cancer. HCC incidence increased on average 4.0% annually (95%CI=3.6%-4.5%). IBM also increased for HCC overall (2.9% annually; 95%CI=1.7%-4.2%) and specifically for localized stage HCC (4.8% annually; 95%CI=4.0%-5.5%). The proportion of HCC-related transplants jumped sharply from 6.7% (2001) to 18.0% (2002), and further increased to 40.0% (2017). HCC-specific mortality declined among both non-transplanted and transplanted cases over time. In the absence of transplants, IBM for localized HCC would have increased at 5.3% instead of 4.8% annually. LT has provided survival benefit to patients with localized HCC. However, diagnosis of many cases at advanced stages, limited availability of donor livers, and improved mortality for non-transplanted patients have limited the impact of transplantation on general population HCC-specific mortality rates. Though LT rates continue to rise, better screening and treatment modalities are needed to halt the rising HCC mortality rates in the US. Copyright ©2020, American Association for Cancer Research.

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