Antiplatelet Drugs on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Outcomes
2.4. Statistical Methods
3. Results
3.1. Baseline Characteristics and Laboratory Results
3.2. Post-Operative Complications
3.3. Kaplan–Meier Analyses in the Matched Cohort
3.4. Multivariate Cox Analyses in the Entire Cohort
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Before Matching | After Matching | |||||
---|---|---|---|---|---|---|
Variables | Antiplatelet (n = 377) | Non-Antiplatelet (n = 91) | p | Antiplatelet (n = 79) | Non-Antiplatelet (n = 79) | SMD |
Age, year | 55 (51–61) | 55.0 (51–59) | 0.977 | 57 (52–62) | 55 (51–59) | 0.026 |
Sex, female | 67 (17.8) | 20 (22.0) | 0.438 | 15 (19.0) | 17 (21.5) | 0.061 |
BMI, kg/m2 | 24.2 (22.5–26.2) | 23.8 (21.9–26.0) | 0.298 | 23.8 (22.1–26.6) | 24.1 (22.1–26.0) | 0.043 |
Year of LT | 0.073 | 0.156 | ||||
2005–2014 | 187 (49.6) | 35 (38.5) | 27 (34.2) | 33 (41.8) | ||
2015–2021 | 190 (50.4) | 56 (61.5) | 52 (65.8) | 46 (58.2) | ||
Underlying liver disease | 0.059 | 0.081 | ||||
HBV | 306 (81.2) | 62 (68.1) | 59 (74.7) | 56 (70.9) | ||
HCV | 23 (6.1) | 9 (9.9) | 11 (13.9) | 6 (7.6) | ||
Alcohol | 28 (7.4) | 12 (13.2) | 4 (5.1) | 11 (13.9) | ||
Others | 20 (5.3) | 8 (8.8) | 5 (6.3) | 6 (7.6) | ||
ABO incompatibility | 54 (14.3) | 19 (20.9) | 0.166 | 19 (24.1) | 16 (20.3) | 0.093 |
Hypertension | 90 (23.9) | 23 (25.3) | 0.885 | 13 (16.5) | 20 (25.3) | 0.104 |
Diabetes | 105 (27.9) | 31 (34.1) | 0.297 | 20 (25.3) | 26 (32.9) | 0.160 |
Cardiovascular disease | 28 (7.4) | 5 (5.5) | 0.676 | 2 (2.5) | 5 (6.3) | 0.167 |
Pre-transplant MELD | 10 (8–14) | 12 (8–16) | 0.023 | 13 (9–17) | 12 (8–16) | 0.073 |
Donor type | 0.917 | 0.064 | ||||
Living | 298 (79.0) | 73 (80.2) | 61 (77.2) | 63 (79.7) | ||
Deceased | 79 (21.0) | 18 (19.8) | 18 (22.8) | 16 (20.3) | ||
Donor age, year | 34 (26–45) | 31 (24–43) | 0.333 | 31 (25–41) | 31 (24–43) | 0.022 |
Donor sex, female | 149 (39.5) | 27 (29.7) | 0.105 | 20 (25.3) | 24 (30.4) | 0.111 |
Graft steatosis >10% | 28 (7.4) | 2 (2.2) | 0.112 | 4 (5.1) | 2 (2.5) | 0.173 |
AFP, ng/mL | 7.3 (3.5–25.0) | 7.5 (3.4–29.2) | 0.973 | 8.2 (4.1–29.7) | 7.3 (3.4–25.4) | 0.028 |
PIVKA II, mAU/mL | 35 (20–97) | 37 (21–111) | 0.598 | 38 (21–97) | 40 (21–114) | 0.081 |
Salvage LT | 52 (13.8) | 11 (12.1) | 0.797 | 9 (11.4) | 11 (13.9) | 0.078 |
Bridging therapy | 0.618 | 0.058 | ||||
Locoregional | 231 (61.3) | 56 (61.5) | 51 (64.6) | 51 (64.6) | ||
None | 108 (28.6) | 23 (25.3) | 21 (26.6) | 19 (24.1) | ||
Systemic | 38 (10.1) | 12 (13.2) | 7 (8.9) | 9 (11.4) | ||
Explant pathology | ||||||
Total necrosis | 56 (14.9) | 15 (16.5) | 0.821 | 13 (16.5) | 13 (16.5) | <0.001 |
Viable tumor number | 1.0 (1.0–3.0) | 1.0 (1.0–3.0) | 0.419 | 1.0 (1.0–3.0) | 1.0 (1.0–2.5) | 0.157 |
Maximum tumor size | 1.8 (1.1–2.8) | 1.8 (1.0–2.8) | 0.812 | 1.6 (1.2–2.5) | 1.7 (1.0–2.8) | 0.094 |
Sum of tumor size | 2.5 (1.1–4.7) | 2.3 (1.0–5.5) | 0.635 | 2.4 (1.2–4.6) | 2.3 (1.0–5.5) | 0.016 |
Microvascular invasion | 87 (23.1) | 20 (22.0) | 0.932 | 19 (24.1) | 20 (25.3) | 0.031 |
Poor differentiation | 107 (28.4) | 30 (33.0) | 0.463 | 31 (39.2) | 25 (31.6) | 0.162 |
Satellite nodule | 37 (9.8) | 7 (7.7) | 0.673 | 4 (5.1) | 6 (7.6) | 0.095 |
Hospital stay, days | 22 (18–29) | 26 (21–41) | 0.001 | 23 (18–34) | 26 (20–36) | 0.156 |
Immunosuppressants a | 0.576 | 0.159 | ||||
Tacrolimus | 128 (34.0) | 26 (28.6) | 14 (17.7) | 22 (27.8) | ||
Tacrolimus +Mycophenolate | 129 (34.2) | 32 (35.2) | 35 (44.3) | 29 (36.7) | ||
Tacrolimus +mTOR inhibitor | 120 (31.8) | 33 (36.3) | 30 (38.0) | 28 (35.4) | ||
Platelet count, k/μL | 77 (56–108) | 71 (51–94) | 0.078 | 68 (52–93) | 71 (51–96) | 0.161 |
Platelet-lymphocyte ratio | 2.9 (1.8–4.6) | 2.8 (2.0–5.4) | 0.923 | 3.0 (2.0–4.4) | 2.8 (2.0–5.7) | 0.152 |
Neutrophil-lymphocyte ratio | 100.0 (70.5–140.7) | 95.4 (76.7–137.7) | 0.820 | 90.2 (60.6–122.4) | 95.4 (76.7–134.3) | 0.134 |
Laboratory results for liver function at 1 month | ||||||
AST, U/L | 25 (17–40) | 24 (15–40) | 0.572 | 26 (19–43) | 23 (15–37) | 0.046 |
ALT, U/L | 27 (15–57) | 25 (17–63) | 0.985 | 27 (15–54) | 25 (17–60) | 0.021 |
Total bilirubin, mg/dL | 0.8 (0.6–1.0) | 0.8 (0.6–1.2) | 0.542 | 0.8 (0.6–1.1) | 0.8 (0.6–1.2) | 0.051 |
INR | 1.0 (0.9–1.0) | 1.0 (0.9–1.1) | 0.003 | 1.0 (0.9–1.0) | 1.0 (0.9–1.1) | 0.033 |
HCC Recurrence a | HCC-Specific Death a | |||||
---|---|---|---|---|---|---|
Variables | HR | 95% CI | p | HR | 95% CI | p |
Antiplatelet group | ||||||
Non-antiplatelet | 1.00 | 1.00 | ||||
Antiplatelet | 0.73 | 0.40–1.32 | 0.300 | 0.65 | 0.28–1.49 | 0.310 |
Age | 0.94 | 0.90–0.98 | 0.008 | |||
Diabetes | 0.57 | 0.33–0.99 | 0.047 | |||
Cardiovascular disease | 1.69 | 0.45–6.29 | 0.430 | |||
Donor age, year | 1.01 | 0.99–1.03 | 0.160 | 1.03 | 1.00–1.05 | 0.031 |
Log AFP | 1.18 | 1.0–1.37 | 0.022 | 1.33 | 1.10–1.59 | 0.003 |
Bridging therapy | ||||||
Locoregional | 1.00 | 1.00 | ||||
None | 0.10 | 0.03–0.35 | <0.001 | 0.13 | 0.04–0.48 | 0.002 |
Systemic | 2.14 | 1.09–4.22 | 0.028 | 3.39 | 1.41–8.13 | 0.006 |
Viable tumor number | 1.06 | 1.01–1.11 | 0.031 | 1.08 | 1.05–1.12 | <0.001 |
Maximum tumor size | 1.18 | 1.06–1.32 | 0.003 | |||
Microvascular invasion | 2.45 | 1.42–4.23 | 0.001 | |||
Poor differentiation | 1.96 | 0.93–4.11 | 0.075 | |||
Satellite nodule | 1.69 | 0.94–3.03 | 0.080 | 4.96 | 2.29–10.7 | <0.001 |
Hospital stay | 1.02 | 1.00–1.04 | 0.100 | 1.03 | 0.99–1.05 | 0.058 |
Immunosuppressants | ||||||
Tacrolimus | 1.00 | |||||
Tacrolimus +Mycophenolate | 0.49 | 0.23–1.04 | 0.063 | |||
Tacrolimus +mTOR inhibitor | 0.29 | 0.12–0.67 | 0.004 | |||
Platelet-lymphocyte ratio | 1.00 | 1.00–1.01 | 0.013 | |||
AST at 1 month, U/L | 1.00 | 1.00–1.01 | 0.280 | 1.00 | 1.00–1.01 | 0.093 |
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Choi, M.C.; Min, E.-K.; Lee, J.G.; Joo, D.J.; Kim, M.S.; Kim, D.-G. Antiplatelet Drugs on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation. Cancers 2022, 14, 5329. https://doi.org/10.3390/cancers14215329
Choi MC, Min E-K, Lee JG, Joo DJ, Kim MS, Kim D-G. Antiplatelet Drugs on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation. Cancers. 2022; 14(21):5329. https://doi.org/10.3390/cancers14215329
Chicago/Turabian StyleChoi, Mun Chae, Eun-Ki Min, Jae Geun Lee, Dong Jin Joo, Myoung Soo Kim, and Deok-Gie Kim. 2022. "Antiplatelet Drugs on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation" Cancers 14, no. 21: 5329. https://doi.org/10.3390/cancers14215329
APA StyleChoi, M. C., Min, E. -K., Lee, J. G., Joo, D. J., Kim, M. S., & Kim, D. -G. (2022). Antiplatelet Drugs on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation. Cancers, 14(21), 5329. https://doi.org/10.3390/cancers14215329