Mo831prognosis of hepatocellular carcinoma in hemodialysis patients

Abstract Background and Aims The aim of this study was to compare the prognosis of hepatocellular carcinoma (HCC) between dialysis and non-dialysis patients. Method In this retrospective observational study, we examined consecutive patients with naïve localized HCC, who were treated with radiofrequency ablation (RFA) between February 2000 and December 2017. The patients were categorized into two subgroups based on whether they were on maintenance dialysis (Dialysis Group, n=458) or not (Non-dialysis Group, n=13), and were followed until December 2019. The primary endpoint was overall survival using Kaplan-Meier analysis. As for propensity score matching, we matched 13 pairs of cases by using age, sex, Child-Pugh score, tumor size, number of tumors and HCV positivity. We also compared causes of death between the 2 groups. Results The study cohort were aged 69.9±9.1 years and included 328 male patients (70%). Hepatitis B was positive in 37 patients (7.9%), C in 322 (68.4%) and co-infection of HBV and HCV was detected in 3 (0.6%). Ninety-five (20.2%) were heavy alcohol drinkers. In Dialysis Group, patients were younger (p=0.004), total bilirubin, AST, ALT levels were significantly lower and PT level was significantly higher. In the entire cohort, overall survival was comparable between Dialysis Group and Non-dialysis Group (5-year survival rate 55.2% vs 52.7%, respectively; p =0.144). In the propensity score matching analysis, however, Dialysis Group showed significantly worse overall survival than Non-dialysis Group (5-year survival rate 52.7% vs 92.3%, respectively; p =0.018). During the observational period, 255 (54%) patients died. As for causes of death, liver-related death occurred in 44% in Dialysis Group and 67% in Non-dialysis Group, whereas cardiovascular death was 22% in Dialysis Group and 5% in Non-dialysis Group. Procedure-related major complication in the first RFA session of each patient was 0% in Dialysis Group. Conclusion Prognosis of hepatocellular carcinoma was poorer in dialysis patients compared to non-dialysis ones, which may be explained by a higher rate of non-liver-related death in dialysis population. Since RFA, per se, has been safely preformed in dialysis patients, prognostic improvement may be expected by treating HCC in dialysis patients as aggressively as in non-dialysis cases.