Impact of Hypothyroidism on Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation

Ahmed Salman; Mohamed Aon; Amr Hussein; Mohamed Salman; Mohamed Tourky; Ahmed Mahmoud; Feras Aljarad; Mohamed Elkaseer; Hossam El-Din Shaaban; Ahmed Moustafa; Ahmed El-Mikkawy; Nahla Gaballa; Heba Abdallah; Zaky Ftouh Zaky Rashed; Hesham Elkassar

doi:10.2147/IJGM.S326315

Impact of Hypothyroidism on Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation

Int J Gen Med. 2021 Sep 16:14:5711-5718. doi: 10.2147/IJGM.S326315. eCollection 2021.

Authors

Affiliations

¹ Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
³ General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Department of Surgery, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
⁵ Senior Clinical Fellow, Great Western Hospital NHS Foundation Trust, Swindon, UK.
⁶ Lewisham and Greenwich NHS Trust, Lewisham, London, UK.
⁷ General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁸ Hepatology and Gastroenterology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
⁹ Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt.
¹⁰ Hepatology and Gastroenterology Department, Theodor Bilharz Research Institute, Cairo, Egypt.
¹¹ Anesthesiology and Intensive Care Department, National Liver Institute, Menoufia University, Shibin El Kom, Egypt.
¹² Clinical Pathology Department, National Liver Institute, Menoufia University, Shibin El Kom, Egypt.
¹³ Anesthesiology and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
¹⁴ Department of Anesthesia, College of Applied Sciences, Almaarefa university, Ad Diriyah, Riyadh, Saudi Arabia.

Abstract

Background: This work endeavored to explore the effect of hypothyroidism on mortality in subjects with HCC who underwent living-donor liver transplantation (LDLT).

Methods: This prospective study included 107 patients with HCC subjected to LDLT, divided into hypothyroid group (n=53) and euthyroid group (n=54). The primary objectives were overall and disease-free survival (DFS).

Results: Euthyroid and hypothyroid groups were comparable in all baseline characteristics except the age of patients. Overall survival (OS) of the whole group at 48 months was 68.8%, while the DFS was 60.2%. On univariate analysis, OS was negatively affected by the older age of the patients (p<0.001) or the donor (p<0.001), hypothyroidism (p=0.008), HBV (p=0.029), larger tumor size (p=0.023), and defective Milan criteria (p=0.022). On multivariate analysis, the age of the patients and donors was the independent factor affecting OS. On univariate analysis, DFS was negatively affected by older age of the patients (p < 0.001) or the donor (p=0.005), hypothyroidism (p=0.005), HBV (p=0.019), larger tumor size (p=0.023), and defective Milan criteria (p=0.020). On multivariate analysis, the age of the patients, thyroid status, and Milan criteria were the independent factors affecting DFS.

Conclusion: Hypothyroidism is a risk factor for worse outcomes in HCC patients after liver transplantation.

Keywords: hepatocellular carcinoma; hypothyroidism; liver transplantation.