Pre-operative BMI and risk of HCC recurrence in liver recipients

Obesity is a well-documented and alterable risk factor for the development of hepatocellular car-cinoma (HCC) in the general population. The applicability of these findings to liver recipients is uncertain, and results of available data have not been unanimous. The objectives of the current study was to investigate the association between the pre-operative body mass index (BMI) and oncological outcomes in liver recipients with HCC in a native liver. Methods: This observational retrospective study enrolled all patients with histologically confirmed HCC who underwent liver transplantation from a deceased donor in our centre between 2008 and 2018. Results: Overall, 83 patients were enrolled and were subsequently stratified according to their pre-operative BMI into 3 Groups: patients with normal body weight (n=53), patients with overweight (n=23), patients with obesity (n=7). Overall tumour recurrence was 12%. Dry-weight-adjusted BMI failed to predict the 5-year recurrence-free survival (p=0.55), risk of tumour recurrence (p=0.314) and overall 5-year survival (p=0.19) in liver recipients. Tumour recurrence constituted the sole determinant of overall 5-year survival (HR: 13.961; 95 CI 3.442-56.6; p<0.001), whereas 5-year recurrence-free survival was independently associated with fulfilment of the Milan criteria (p=0.46), a lack of microvascular invasion (p=0.01) and a low AFP level at baseline (p=0.03). Conclusions: BMI was proven to be an unreliable surrogate measure of obesity for predicting oncological outcomes among liver transplant recipients. Other obesity indices should be referenced in order to assess cancer-related prognosis more accurately in patients with chronic liver disease.