Publication Name	World Journal of Transplantation
Manuscript ID	109609
Country	United States

Category	Gastroenterology & Hepatology
Manuscript Type	Observational Study
Article Title	Association of vascular invasion and tumor differentiation on post-liver transplant outcomes in patients with hepatocellular carcinoma
Manuscript Source	Invited Manuscript
All Author List	Nazlı Begüm Öztürk, Merve M Gurakar, Ximena Parraga, Marwan Alsaqa, Leandro Sierra, Emily Currier, Butros Fakhoury, Alan Bonder, Ahmet Gurakar and Behnam Saberi
Funding Agency and Grant Number
Corresponding Author	Ahmet Gurakar, MD, Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Suite 918, Baltimore, MD 21205, United States. aguraka1@jhmi.edu
Key Words	Hepatocellular carcinoma; Recurrence; Transplant; Vascular invasion; Cirrhosis
Core Tip	Liver transplant (LT) is one of the treatment options for hepatocellular carcinoma (HCC). Macrovascular invasion and tumor differentiation have been shown to be associated with post-LT HCC recurrence. We investigated a large national transplant database in the United States to identify post-LT survival in HCC patients between 2012 and 2022. A total of 13638 patients with HCC and available liver explant data were included. Of the cohort, 254 (1.8%) demonstrated macrovascular invasion and 1712 (12.6%) had microvascular invasion (MVI). Poor tumor differentiation was most frequent in the macrovascular invasion cohort compared to the microvascular and absent invasion cohorts. Post-transplant survival at 1 year, 3 years, and 5 years was lowest among patients with macrovascular invasion, lower than in those with MVI and lower still than in those without vascular invasion. Likewise, on explant pathology, poor differentiation was linked to worse 1-year, 3-year, and 5-year survival than either well-differentiated tumors or complete necrosis. Macrovascular invasion and poor tumor differentiation on liver explants in patients with HCC were associated with significantly higher post-LT mortality, meaning that the extent of tumor involvement and tumor biology are important predictors of post-LT survival in HCC.
Citation	Öztürk NB, Gurakar MM, Parraga X, Alsaqa M, Sierra L, Currier E, Fakhoury B, Bonder A, Gurakar A, Saberi B. Association of vascular invasion and tumor differentiation on post-liver transplant outcomes in patients with hepatocellular carcinoma. World J Transplant 2025; In press

Received	2025-05-16 07:24
Peer-Review Started	2025-05-16 07:25
To Make the First Decision
Return for Revision	2025-06-05 03:23
Revised	2025-06-19 01:36
Second Decision	2025-09-22 02:45
Accepted by Journal Editor-in-Chief
Accepted by Executive Editor-in-Chief	2025-09-22 09:48
Articles in Press	2025-09-22 09:48
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ISSN	2220-3230 (online)
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