Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 4785-4798
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4785
Impact of COVID-19 pandemic on clinicopathological features of transplant recipients with hepatocellular carcinoma: A case-control study
Sami Akbulut, Tevfik Tolga Sahin, Volkan Ince, Sezai Yilmaz
Sami Akbulut, Tevfik Tolga Sahin, Volkan Ince, Sezai Yilmaz, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Author contributions: Akbulut S and Ince V collected the data; Akbulut S performed the statistical analysis; Akbulut S and Sahin TT wrote the manuscript; Akbulut S, Sahin TT and Yilmaz S developed the study and reviewed the final version.
Institutional review board statement: This study was reviewed and approved by the Inonu University institutional review board for non-interventional studies, No. 2021/2538.
Informed consent statement: Verbal and written consents were obtained from all HCC patients before the liver transplantation procedure.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest regarding this study.
Data sharing statement: There are no additional data available for this study.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, FACS, MD, PhD, Professor, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10.Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: December 14, 2021
Peer-review started: December 14, 2021
First decision: March 12, 2022
Revised: March 17, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 26, 2022
Processing time: 160 Days and 18.8 Hours
ARTICLE HIGHLIGHTS
Research background

Coronavirus disease 2019 (COVID-19) has overwhelmed the healthcare services all around the world. The organization of healthcare facilities were changed and treatment of many diseases such as heart disease, liver disease and various cancers have been postponed until the pandemic was under control. Hepatocellular carcinoma (HCC) is an aggressive disease that shows progression without any intervention. Therefore, the impact of COVID-19 in the management of progressive diseases such as HCC needs to be investigated.

Research motivation

COVID-19 has overwhelmed the everyday healthcare services. Treatment of many cancers such as liver cancer have been postponed until the COVID-19 pandemic was under control. A delay in the treatment of HCC has serious consequences that would reflect the clinical and tumor characteristics of the patients.

Research objectives

The main objective was to compare the demographic, clinical and histopathologic characteristics of the patients with HCC who have undergone liver transplantation during the COVID-19 pandemic with the patients in the pre-pandemic period. We aimed to define any change in the tumor behavior or any change in the management of these patients during the COVID-19 pandemic.

Research methods

Demographic, clinicopathological variables of patients with HCC who have undergone liver transplantation between March 2020 and June 2021 (Pandemic group, n = 48) were retrospectively compared with that of the patients with HCC transplanted between November 2018 and March 2020 (Pre-pandemic group, n = 61).

Research results

Ninety-seven patients (89%) were male, and 12 were female (11%). The most common etiology of liver disease was hepatitis B virus (n = 52, 47.7%). Statistically significant differences were found between groups in terms of blood alkaline phosphatase levels (P = 0.029), lymphovascular invasion (P = 0.019) and type of the liver graft that was transplanted (P = 0.017). In patients who were transplanted for HCC in the COVID-19 period, the use of grafts from the living donors was 13.3 times more frequent than the pre-COVID-19 period [odds ratio = 13.3; 95% confidence interval (CI): 0.74-240]. The rate of lymphovascular invasion in the explant pathologies of patients was found to be 2.54 times more frequent in patients who received operations during the COVID-19 period (odds ratio = 2.54; 95%CI: 1.15-5.56).

Research conclusions

This study showed that there was only a modest change in the tumor biology during the COVID-19 pandemic. This shows the efficacy of our surveillance program that enabled transplanting patients with HCC according to conventional management protocols.

Research perspectives

We believe that the increased lymphovascular invasion rate in the present study was an observational variation because there is no change in the stages of the diseases between the two intervals. The DDLT rate in Turkey was already low, and it further decreased during the pandemic. However, we managed to preserve a high rate of LDLT. Therefore, it is important to develop a surveillance strategy for liver transplant centers. The liver transplantation for HCC is justified and safe provided that strict surveillance protocols are applied.