Causes of death after liver transplantation among patients with solitary hepatocellular carcinoma in the United State, from 2004 to 2015.

Liver transplantation has gained broad acceptance as a therapeutic modality for hepatocellular carcinoma (HCC), with better overall survival than liver resection [1]. The United Network for Organ Sharing (UNOS) adopted Milan criteria for liver transplantation in patients with HCC (single lesion, diameter ≤ 50 mm, without vascular invasion, and with no metastasis) to improve survival [2]. Yang et al. reported that the median overall survival is 5.75 years after transplantation for patients meeting UNOS criteria [1]. So, even though choosing these criteria is a focal point, there is another important topic, i.e. knowing the causes of death after selecting these criteria. However, the causes of death are unclear. We used Surveillance, Epidemiology, and End Results (seer)*stat software, latest version 8.3.9.2 in our study to access SEER plus data, 18 registries [3, 4]. We identified the solitary HCC diagnosis with the primary site labelled C22.0, specific ICD-O-3 hist/behave (8170/3 – 8175/3) and concerning UNOS criteria (CS extension 2004–2015). We evaluated causes of death (ICD-10 identifications) and calculated the standardized mortality ratio (SMR), which represents the number of observed deaths from a specific cause to the number that would be expected to die over a given period. Therefore, understanding the distribution of different causes of death after liver transplantation among HCC patients is helpful in counselling patients regarding their care and survivorship. We reviewed 1260 US patients with solitary HCC who had undergone liver transplants during the period 2004–2015 (Figure 1). Most patients were aged between 45 and 79 years (1204; 95.6%), were white (1002; 79.5), male (960; 76%), married (805; 63.9%), and with a localized stage (1227; 97.4%). Of the included patients 400 (31.7%) died during this period, with a mean age