High Incidence of Undiagnosed Hepatocellular Carcinoma in Transplant Recipients With Metabolic‐Associated Steatotic Liver Disease
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2026
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| author | Emily A. Leven Ishaan Dharia Natalia Schmidt Haley Waite Pu Ni M. Isabel Fiel Emre Altinmakas Deborah Feldman Thomas D. Schiano Lauren T. Grinspan |
| author_facet | Emily A. Leven Ishaan Dharia Natalia Schmidt Haley Waite Pu Ni M. Isabel Fiel Emre Altinmakas Deborah Feldman Thomas D. Schiano Lauren T. Grinspan Emily A. Leven Ishaan Dharia Natalia Schmidt Haley Waite Pu Ni M. Isabel Fiel Emre Altinmakas Deborah Feldman Thomas D. Schiano Lauren T. Grinspan |
| collection | Wiley Open Access |
| contents | High Incidence of Undiagnosed Hepatocellular Carcinoma in Transplant Recipients With Metabolic‐Associated Steatotic Liver Disease Emily A. Leven Ishaan Dharia Natalia Schmidt Haley Waite Pu Ni M. Isabel Fiel Emre Altinmakas Deborah Feldman Thomas D. Schiano Lauren T. Grinspan Clinical Transplantation ABSTRACT Background A minority of liver transplant (LT) recipients are not diagnosed with HCC (u‐HCC) until their explanted liver is examined. The primary aim of this study was to examine HCC screening before LT in patients with u‐HCC compared to those with known HCC (k‐HCC). Secondary aims included assessment of inter‐reader variability of diagnostic imaging used for HCC screening; predictors of u‐HCC; and post‐LT outcomes in u‐HCC. Methods A single center retrospective review of patients with HCC on explant from 2012‐2023 was performed. A randomized subset of imaging studies from patients with k‐HCC and u‐HCC was reevaluated by two independent, blinded radiologists and inter‐reader concordance was measured. Results Thirty‐seven (7.8%) patients had u‐HCC, of whom 26 (70.3%) underwent contrast‐enhanced magnetic resonance imaging (MRI) and 11 (29.7%) underwent computed tomography with delayed contrast phase (73% within 6 months of LT). Patients with metabolic liver disease and steatohepatitic HCC were more likely to have u‐HCC (32% vs 16%, p = 0.01; 19% vs 7%, p = 0.01, respectively). Thirty‐two patients with u‐HCC had no suspicious lesions noted on imaging. 60% of all studies with second evaluation by blinded radiologists had concordant findings compared to 44% in metabolic liver disease. Conclusions Patients with metabolic liver disease may be at higher risk of u‐HCC compared to other etiologies of liver disease despite regular, contrast‐enhanced, cross‐sectional imaging. One possible explanation for this is the difficulty of HCC detection in metabolic liver disease, as demonstrated by greater likelihood of inter‐reader discordance in imaging assessment in these patients. Keywords (Index Medicus) 10.1111/ctr.70506 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70506 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70506 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | High Incidence of Undiagnosed Hepatocellular Carcinoma in Transplant Recipients With Metabolic‐Associated Steatotic Liver Disease Emily A. Leven Ishaan Dharia Natalia Schmidt Haley Waite Pu Ni M. Isabel Fiel Emre Altinmakas Deborah Feldman Thomas D. Schiano Lauren T. Grinspan Clinical Transplantation High Incidence of Undiagnosed Hepatocellular Carcinoma in Transplant Recipients With Metabolic‐Associated Steatotic Liver Disease Emily A. Leven Ishaan Dharia Natalia Schmidt Haley Waite Pu Ni M. Isabel Fiel Emre Altinmakas Deborah Feldman Thomas D. Schiano Lauren T. Grinspan Clinical Transplantation ABSTRACT Background A minority of liver transplant (LT) recipients are not diagnosed with HCC (u‐HCC) until their explanted liver is examined. The primary aim of this study was to examine HCC screening before LT in patients with u‐HCC compared to those with known HCC (k‐HCC). Secondary aims included assessment of inter‐reader variability of diagnostic imaging used for HCC screening; predictors of u‐HCC; and post‐LT outcomes in u‐HCC. Methods A single center retrospective review of patients with HCC on explant from 2012‐2023 was performed. A randomized subset of imaging studies from patients with k‐HCC and u‐HCC was reevaluated by two independent, blinded radiologists and inter‐reader concordance was measured. Results Thirty‐seven (7.8%) patients had u‐HCC, of whom 26 (70.3%) underwent contrast‐enhanced magnetic resonance imaging (MRI) and 11 (29.7%) underwent computed tomography with delayed contrast phase (73% within 6 months of LT). Patients with metabolic liver disease and steatohepatitic HCC were more likely to have u‐HCC (32% vs 16%, p = 0.01; 19% vs 7%, p = 0.01, respectively). Thirty‐two patients with u‐HCC had no suspicious lesions noted on imaging. 60% of all studies with second evaluation by blinded radiologists had concordant findings compared to 44% in metabolic liver disease. Conclusions Patients with metabolic liver disease may be at higher risk of u‐HCC compared to other etiologies of liver disease despite regular, contrast‐enhanced, cross‐sectional imaging. One possible explanation for this is the difficulty of HCC detection in metabolic liver disease, as demonstrated by greater likelihood of inter‐reader discordance in imaging assessment in these patients. Keywords (Index Medicus) 10.1111/ctr.70506 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | High Incidence of Undiagnosed Hepatocellular Carcinoma in Transplant Recipients With Metabolic‐Associated Steatotic Liver Disease |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70506 |