Antiplatelet Drugs on the Recurrence of Hepatocellular Carcinoma after Liver Transplantation

Abstract

Simple Summary Recently, antiplatelet agents have been shown to have anticancer effects, especially for hepatocellular carcinoma (HCC) but have never been studied in liver transplantation (LT) recipients. We investigated 468 LT patients to ensure that antiplatelet drugs (aspirin or clopidogrel) could prevent HCC recurrence after LT. In matched patients, the 5-year incidence of HCC recurrence (15.8% versus 20.4%) and death from HCC (18.3% versus 15.4%) were not significantly different between the antiplatelet and non-antiplatelet groups. When adjusted for other risk factors of HCC recurrence, antiplatelet use was not associated with HCC recurrence. Unlike in non-recipients with liver disease, antiplatelet therapy did not affect HCC recurrence or death from HCC when used after LT. Previous studies reported suppressive effects of antiplatelet agents on hepatocellular carcinoma (HCC); however, this has never been assessed in patients who underwent liver transplantation (LT). This retrospective observational study used data from LT recipients with pre-transplant HCC in a single tertiary hospital. The study population was divided into two groups according to the use of antiplatelet agents for >90 days within the study period (377 antiplatelet groups versus 91 non-antiplatelet groups). Matched groups containing 79 patients in each group were also compared regarding HCC-recurrence and HCC-related mortality, which were analyzed by treating non-HCC death as a competing risk. In Kaplan-Meier analyses of the matched cohort, the 5-year cumulative incidences of HCC recurrence and HCC-specific death were similar between the antiplatelet (p = 0.876) and non-antiplatelet groups (p = 0.701). All-cause and non-HCC deaths were also similar between the two groups (p = 0.867 and p = 0.413, respectively). In multivariable analyses of the entire cohort, antiplatelet use was not associated with HCC recurrence (hazard ratio [HR] 1.37, p = 0.300) or HCC-specific death (HR 1.54, p = 0.310). Therefore, unlike the usual setting with liver disease, antiplatelet therapy did not affect HCC recurrence or HCC-specific mortality when used after LT.