ArticleJournal of gastroenterology2022
The absence of warfarin treatment and situs inversus are associated with the occurrence of hepatocellular carcinoma after Fontan surgery.
Article in Journal of gastroenterology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 18 citations in OpenAlex.
- YAP1 induces hepatocellular carcinoma via DNA demethylation rather than by canonical driver gene mutations.Communications biology · 2026Article
- Noninvasive risk stratification of liver nodule development in Fontan-associated liver disease using liver stiffness measurement.Hepatology international · 2026Article
- Hepatocellular carcinoma in Fontan-associated liver disease: Incidence, risk stratification, and surveillance implications.Hepatology communications · 2026Article
- Target neutrophil heterogeneity and plasticity in cancer.Journal of hematology & oncology · 2025Review
- Review
- Fontan-Associated Liver Disease.Seminars in liver disease · 2025Review
- Impact of ursodeoxycholic acid treatment on Fontan-associated liver disease.Journal of gastroenterology · 2025Article
- Thromboprophylaxis strategies for patients with a Fontan palliation: practice in the NHS.The British journal of cardiology · 2025Article
- Fontan-associated liver disease: the importance of multidisciplinary teamwork in its management.Frontiers in medicine · 2024Review
- Surgical treatment of hepatocellular carcinoma after Fontan operation: three case reports and review of the literature.Clinical journal of gastroenterology · 2023Review
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHepatocellular carcinoma (HCC) is a long-term complication of Fontan-associated liver disease (FALD). However, risk factors for HCC in patients with FALD remain unclear. This study aimed to identify factors associated with HCC development post-Fontan procedure.
methodsWe retrospectively examined 103 post-Fontan patients who underwent hepatic imaging at our institution. HCC incidence and patient characteristics were analyzed. A Cox proportional hazards model was used to identify risk factors for HCC.
resultsThe median interval between Fontan surgery and final hepatic imaging was 19.6 (1.0-37.7) years. Among 103 patients, nine developed HCC. The cumulative incidence rates of HCC at 10, 20, and 30 years postoperatively were 0%, 7%, and 13%, respectively. In the univariate analysis, age at Fontan surgery, situs inversus, and warfarin absence were associated with HCC occurrence. The multivariate analysis identified the warfarin absence (adjusted hazard ratio [aHR], 22.71; 95% confidence interval: 3.29-507.1; p = 0.0005) and situs inversus (aHR, 14.36; 95% confidence interval: 2.75-105.5; p = 0.002) as risk factors. The prevalence of situs inversus and the warfarin absence was 12% and 50%, respectively. The 20- and 30-year incidence rates of HCC among patients who received warfarin were 0% and 7%, respectively, while those among patients who did not receive warfarin were 14% and 21%, respectively. HCC incidence was significantly higher in the non-warfarin group than in the warfarin group (p = 0.006) and among patients with situs inversus than among those with situs solitus (p = 0.004).
conclusionsWarfarin absence and situs inversus were associated with HCC development post-Fontan procedure.
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