Prevalence of hepatic iron overload and association with hepatocellular cancer in end-stage liver disease: Results from the National Hemochromatosis Transplant Registry

Cynthia Ko, Narendra Siddaiah, Jose Berger, Robert Gish, David Brandhagen, Richard K. Sterling, Scott J. Cotler, Robert J. Fontana, Timothy M McCashland, Steven H B Han, Frederic D. Gordon, Michael L. Schilsky, Kris V. Kowdley

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: It is unclear whether mild to moderate iron overload in liver diseases other than hereditary haemochromatosis (HH) contributes to hepatocellular carcinoma. This study examined the association between hepatic iron grade and hepatocellular carcinoma in patients with end-stage liver disease of diverse aetiologies. Methods: The prevalence of hepatic iron overload and hepatocellular carcinoma was examined in 5224 patients undergoing liver transplantation. Explant pathology reports were reviewed for the underlying pathological diagnosis, presence of hepatocellular carcinoma and degree of iron staining. The distribution of categorical variables was studied using χ2 tests. Results: Both iron overload and hepatocellular carcinoma were the least common with biliary cirrhosis (1.8 and 2.8% respectively). Hepatocellular carcinoma was the most common in patients with hepatitis B (16.7%), followed by those with hepatitis C (15.1%) and HH (14.9%). In the overall cohort, any iron overload was significantly associated with hepatocellular carcinoma (P = 0.001), even after adjustment for the underlying aetiology of liver disease. The association between hepatic iron content and hepatocellular carcinoma was the strongest in patients with biliary cirrhosis (P < 0.001) and hepatitis C (P < 0.001). Conclusions: Iron overload is associated with hepatocellular carcinoma in patients with end-stage liver disease, suggesting a possible carcinogenic or cocarcinogenic role for iron in chronic liver disease.

Original languageEnglish (US)
Pages (from-to)1394-1401
Number of pages8
JournalLiver International
Volume27
Issue number10
DOIs
StatePublished - Dec 1 2007

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End Stage Liver Disease
Iron Overload
Hemochromatosis
Liver Neoplasms
Registries
Hepatocellular Carcinoma
Transplants
Liver
Iron
Liver Diseases
Biliary Liver Cirrhosis
Hepatitis C
Hepatitis B
Liver Transplantation
Chronic Disease
Pathology
Staining and Labeling

Keywords

  • Cirrhosis
  • Hepatocellular carcinoma
  • Iron overload
  • Liver transplantation

ASJC Scopus subject areas

  • Hepatology

Cite this

Prevalence of hepatic iron overload and association with hepatocellular cancer in end-stage liver disease : Results from the National Hemochromatosis Transplant Registry. / Ko, Cynthia; Siddaiah, Narendra; Berger, Jose; Gish, Robert; Brandhagen, David; Sterling, Richard K.; Cotler, Scott J.; Fontana, Robert J.; McCashland, Timothy M; Han, Steven H B; Gordon, Frederic D.; Schilsky, Michael L.; Kowdley, Kris V.

In: Liver International, Vol. 27, No. 10, 01.12.2007, p. 1394-1401.

Research output: Contribution to journalArticle

Ko, C, Siddaiah, N, Berger, J, Gish, R, Brandhagen, D, Sterling, RK, Cotler, SJ, Fontana, RJ, McCashland, TM, Han, SHB, Gordon, FD, Schilsky, ML & Kowdley, KV 2007, 'Prevalence of hepatic iron overload and association with hepatocellular cancer in end-stage liver disease: Results from the National Hemochromatosis Transplant Registry', Liver International, vol. 27, no. 10, pp. 1394-1401. https://doi.org/10.1111/j.1478-3231.2007.01596.x
Ko, Cynthia ; Siddaiah, Narendra ; Berger, Jose ; Gish, Robert ; Brandhagen, David ; Sterling, Richard K. ; Cotler, Scott J. ; Fontana, Robert J. ; McCashland, Timothy M ; Han, Steven H B ; Gordon, Frederic D. ; Schilsky, Michael L. ; Kowdley, Kris V. / Prevalence of hepatic iron overload and association with hepatocellular cancer in end-stage liver disease : Results from the National Hemochromatosis Transplant Registry. In: Liver International. 2007 ; Vol. 27, No. 10. pp. 1394-1401.
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abstract = "Background: It is unclear whether mild to moderate iron overload in liver diseases other than hereditary haemochromatosis (HH) contributes to hepatocellular carcinoma. This study examined the association between hepatic iron grade and hepatocellular carcinoma in patients with end-stage liver disease of diverse aetiologies. Methods: The prevalence of hepatic iron overload and hepatocellular carcinoma was examined in 5224 patients undergoing liver transplantation. Explant pathology reports were reviewed for the underlying pathological diagnosis, presence of hepatocellular carcinoma and degree of iron staining. The distribution of categorical variables was studied using χ2 tests. Results: Both iron overload and hepatocellular carcinoma were the least common with biliary cirrhosis (1.8 and 2.8{\%} respectively). Hepatocellular carcinoma was the most common in patients with hepatitis B (16.7{\%}), followed by those with hepatitis C (15.1{\%}) and HH (14.9{\%}). In the overall cohort, any iron overload was significantly associated with hepatocellular carcinoma (P = 0.001), even after adjustment for the underlying aetiology of liver disease. The association between hepatic iron content and hepatocellular carcinoma was the strongest in patients with biliary cirrhosis (P < 0.001) and hepatitis C (P < 0.001). Conclusions: Iron overload is associated with hepatocellular carcinoma in patients with end-stage liver disease, suggesting a possible carcinogenic or cocarcinogenic role for iron in chronic liver disease.",
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AU - Siddaiah, Narendra

AU - Berger, Jose

AU - Gish, Robert

AU - Brandhagen, David

AU - Sterling, Richard K.

AU - Cotler, Scott J.

AU - Fontana, Robert J.

AU - McCashland, Timothy M

AU - Han, Steven H B

AU - Gordon, Frederic D.

AU - Schilsky, Michael L.

AU - Kowdley, Kris V.

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