Clin Transplant. 2026 Mar;40(3):e70506. doi: 10.1111/ctr.70506.
ABSTRACT
BACKGROUND: A minority of liver transplant (LT) recipients are not diagnosed with HCC (u-HCC) until their explanted liver is examined. The primary aim of this study was to examine HCC screening before LT in patients with u-HCC compared to those with known HCC (k-HCC). Secondary aims included assessment of inter-reader variability of diagnostic imaging used for HCC screening; predictors of u-HCC; and post-LT outcomes in u-HCC.
METHODS: A single center retrospective review of patients with HCC on explant from 2012-2023 was performed. A randomized subset of imaging studies from patients with k-HCC and u-HCC was reevaluated by two independent, blinded radiologists and inter-reader concordance was measured.
RESULTS: Thirty-seven (7.8%) patients had u-HCC, of whom 26 (70.3%) underwent contrast-enhanced magnetic resonance imaging (MRI) and 11 (29.7%) underwent computed tomography with delayed contrast phase (73% within 6 months of LT). Patients with metabolic liver disease and steatohepatitic HCC were more likely to have u-HCC (32% vs 16%, p = 0.01; 19% vs 7%, p = 0.01, respectively). Thirty-two patients with u-HCC had no suspicious lesions noted on imaging. 60% of all studies with second evaluation by blinded radiologists had concordant findings compared to 44% in metabolic liver disease.
CONCLUSIONS: Patients with metabolic liver disease may be at higher risk of u-HCC compared to other etiologies of liver disease despite regular, contrast-enhanced, cross-sectional imaging. One possible explanation for this is the difficulty of HCC detection in metabolic liver disease, as demonstrated by greater likelihood of inter-reader discordance in imaging assessment in these patients. KEYWORDS (INDEX MEDICUS).
PMID:41848630 | DOI:10.1111/ctr.70506
