Special Populations: Hepatocellular Carcinoma Risk and Liver Transplantation

Area of Science:

• Hepatology
• Oncology
• Metabolic Disorders

Background:

• Metabolic dysfunction-associated steatotic liver disease/steatohepatitis (MASLD/MASH) is a growing cause of liver cancer (hepatocellular carcinoma, HCC).
• MASLD/MASH-related HCC is a significant concern in liver transplantation candidates.
• While cirrhosis is common, up to 40% of MASLD/MASH patients with HCC may lack clear signs of cirrhosis.

Purpose of the Study:

• To highlight the rising incidence of HCC in MASLD/MASH patients.
• To address the gap in current HCC surveillance guidelines for MASLD/MASH patients without cirrhosis.
• To advocate for an individualized approach to HCC surveillance in this population.

Main Methods:

• Review of existing literature on MASLD/MASH and HCC.
• Analysis of patient data regarding cirrhosis status and HCC development.
• Comparison of current HCC surveillance guidelines with clinical observations.

Main Results:

• MASLD/MASH is a leading driver of HCC, particularly in liver transplant populations.
• A substantial proportion of MASLD/MASH patients with HCC do not present with overt cirrhosis.
• Current surveillance strategies, focused on cirrhosis, may under-detect HCC in non-cirrhotic MASLD/MASH patients.

Conclusions:

• There is a critical need to re-evaluate HCC surveillance protocols for MASLD/MASH patients.
• An individualized, risk-based approach is necessary for patients with MASLD/MASH, especially those without clinical cirrhosis.
• Early detection of HCC in MASLD/MASH patients requires broader surveillance considerations beyond established cirrhosis criteria.