Background
Methods
Study design and patient selection
Data collection
Data and statistical analysis
Results
Patients characteristics
Variables | N = 720 |
---|---|
Age, year (mean, SD) | 57.7 (12.1) |
Male Sex, % | 450 (62.5%) |
BMI, kg/m2, (mean, SD) | 29.4 (6.3) |
Obesity, % | 285 (39.6%) |
White, % | 636 (88.3%) |
African American, % | 32 (4.4%) |
Asian, % | 17 (2.4%) |
Other Race, % | 35 (4.9%) |
Hispanic/Latino, % | 48 (6.7%) |
History of Moderate Alcohol Use, % | 142 (19.7%) |
Ever smoked, % | 399 (55.4%) |
Current smoker, % | 19 (2.6%) |
Sodium, mmol/L (mean, SD) | 138 (4.1) |
Total Bilirubin, mg/dL (mean, SD) | 2.7 (4.2) |
INR, (mean, SD) | 1.4 (0.4) |
Creatinine, mg/dL (mean, SD) | 1.0 (0.5) |
MELD, (mean, SD) | 14.4 (6.9) |
MELD ≥ 18, % | 201 (27.9%) |
MELD ≥ 26, % | 49 (6.8%) |
Etiology of Cirrhosis | |
A1AT Deficiency, % | 17 (2.4%) |
Alcohol, % | 148 (20.6%) |
Autoimmune, % | 45 (6.3%) |
Cryptogenic, % | 49 (6.81%) |
Hemochromatosis, % | 9 (1.3%) |
Hepatitis B, % | 18 (2.5%) |
Hepatitis C, % | 159 (22.1%) |
NASH, % | 179 (24.9%) |
Other, % | 16 (2.2%) |
Primary Biliary Cirrhosis, % | 32 (4.4%) |
Primary Sclerosing Cholangitis, % | 45 (6.3%) |
Wilson’s Disease, % | 3 (0.4%) |
History of prior TIPS | 38 (5.3%) |
Incidentaloma Discovered | 574 (79.7%) |
Transplanted at End of Study | 532 (73.9%) |
Incidentaloma Absent N = 146 | Incidentaloma Discovered N = 574 | p value | |
---|---|---|---|
Age, year (mean, SD) | 50.5 (15.5) | 59.6 (10.2) | < 0.0011 |
Male Sex, % | 85 (58.2%) | 365 (63.6%) | 0.2312 |
BMI, kg/m2, (mean, SD) | 28.6 (6.6) | 29.6 (6.2) | 0.08481 |
Obesity, % | 56 (38.4% | 229 (39.9%) | 0.7342 |
White, % | 126 (86.3%) | 510 (88.9%) | 0.3922 |
African American, % | 7 (4.8%) | 25 (4.4%) | 0.8223 |
Asian, % | 4 (2.7%) | 13 (2.3%) | 0.7603 |
Other Race, % | 9 (6.2%) | 26 (4.5%) | 0.3933 |
Hispanic/Latino, % | 10 (6.8%) | 38 (6.6%) | 0.8553 |
History of Moderate Alcohol Use, % | 25 (17.1%) | 117 (20.4%) | 0.3772 |
Ever smoked, % | 73 (50.0%) | 326 (56.8%) | 0.1402 |
Current smoker, % | 6 (4.1%) | 13 (2.3%) | 0.2443 |
Sodium, mmol/L (mean, SD) | 137.5 (3.9) | 138.1 (4.1) | 0.14031 |
Total Bilirubin, mg/dL (mean, SD) | 3.5 (5.4) | 2.5 (3.8) | 0.04471 |
INR, (mean, SD) | 1.4 (0.5) | 1.4 (0.4) | 0.53121 |
Creatinine, mg/dL (mean, SD) | 1.0 (0.6) | 1.0 (0.5) | 0.67001 |
MELD, (mean, SD) | 15.1 (7.2) | 14.2 (6.9) | 0.17641 |
MELD ≥ 18, % | 47 (32.2%) | 154 (26.8%) | 0.2152 |
MELD ≥ 26, % | 12 (8.2%) | 37 (6.4%) | 0.4623 |
Etiology of Cirrhosis | 0.9312 | ||
NASH, % | 31 (21.2%) | 148 (25.8%) | 0.2562 |
Hepatitis C, % | 29 (19.9%) | 130 (22.6%) | 0.4692 |
Alcohol, % | 28 (19.2%) | 120 (20.9%) | 0.6452 |
History of prior TIPS | 7 (4.8%) | 31 (5.4%) | 1.0003 |
Transplanted at end of study | 98 (67.1%) | 434 (75.6%) | 0.0372 |
Not Transplanted N = 188 | Transplanted N = 532 | p value | |
---|---|---|---|
Age, year (mean, SD) | 59.2 (14.5) | 57.2 (11.0) | 0.07901 |
Male Sex, % | 102 (54.3%) | 348 (65.4%) | 0.0072 |
BMI, kg/m2, (mean, SD) | 29.3 (6.9) | 29.4 (6.0) | 0.77771 |
Obesity, % | 74 (39.4%) | 211 (39.7%) | 0.9422 |
White, % | 166 (88.3%) | 470 (88.3%) | 0.9862 |
African American, % | 10 (5.3%) | 22 (44.1%) | 0.5373 |
Asian, % | 5 (2.7%) | 12 (2.3%) | 0.7813 |
Other Race, % | 7 (3.7%) | 28 (5.3%) | 0.5543 |
Hispanic/Latino, % | 8 (4.3%) | 40 (7.5%) | 0.1723 |
History of Moderate Alcohol Use, % | 29 (15.4%) | 113 (21.2%) | 0.085 |
Ever smoked, % | 90 (47.9%) | 309 (58.1%) | 0.0152 |
Current smoker, % | 19 (10.1%) | 0 (0.0%) | < 0.0013 |
Sodium, mmol/L (mean, SD) | 139.2 (3.0) | 137.5 (4.3) | < 0.0011 |
Total Bilirubin, mg/dL (mean, SD) | 1.3 (2.4) | 3.2 (4.5) | < 0.0011 |
INR, (mean, SD) | 1.2 (0.3) | 1.4 (0.5) | < 0.0011 |
Creatinine, mg/dL (mean, SD) | 1.0 (0.4) | 1.0 (0.6) | 0.18341 |
MELD, (mean, SD) | 10.4 (4.3) | 15.8 (7.1) | < 0.0011 |
MELD ≥ 18 | 11 (5.9%) | 190 (35.7%) | < 0.0013 |
MELD ≥ 26 | 1 (0.5%) | 48 (9.0%) | < 0.0013 |
Etiology of Cirrhosis | 0.0562 | ||
NASH, % | 52 (27.7%) | 127 (23.9%) | 0.3022 |
Hepatitis C, % | 31 (16.5%) | 128 (24.1%) | 0.0312 |
Alcohol, % | 29 (15.4%) | 119 (22.4%) | 0.0412 |
History of prior TIPS | 6 (3.2%) | 32 (6.0%) | 0.1833 |
Incidentaloma Discovered | 140 (74.5%) | 434 (81.6%) | 0.037 |
Kaplan Meier analysis
Cox proportional hazards regression analysis
HR | 2.5% | 97.5% | p-value | |
---|---|---|---|---|
Age, per 1 year | 1.0000 | 0.9900 | 1.0100 | 0.9172 |
Age [18,40) years | 0.9100 | 0.6800 | 1.2200 | 0.5397 |
Age [40,50) years | 0.9000 | 0.6900 | 1.1800 | 0.4552 |
Age [50,65) years | 1.1500 | 0.9700 | 1.3700 | 0.0993 |
Age ≥ 65 years | 0.9300 | 0.7700 | 1.1200 | 0.9300 |
Male Sex | 1.2800 | 1.0700 | 1.5300 | 0.0075 |
BMI, per 1 kg/m2 | 0.9900 | 0.9800 | 1.0100 | 0.3536 |
Obesity | 0.9500 | 0.8000 | 1.1300 | 0.5819 |
White | 0.8800 | 0.6700 | 1.1400 | 0.3303 |
African American | 0.8557 | 0.6300 | 1.4700 | 0.8557 |
Asian | 0.9364 | 0.5800 | 1.8200 | 0.9364 |
Other Race | 1.3800 | 0.9400 | 2.0200 | 0.0963 |
Hispanic/Latino | 1.3600 | 0.9900 | 1.8800 | 0.0611 |
History of Moderate Alcohol Use | 1.5200 | 1.2400 | 1.8800 | < 0.0001 |
Ever smoked | 1.2100 | 1.0200 | 1.4400 | 0.0293 |
Sodium, per 1 mmol/L | 0.9300 | 0.9100 | 0.9500 | < 0.0001 |
Total Bilirubin, per 1 mg/dL | 1.1500 | 1.1300 | 1.1700 | < 0.0001 |
INR, per 1 point | 2.5300 | 2.1800 | 2.9400 | < 0.0001 |
Creatinine, per 1 mg/dL point | 1.3300 | 1.1500 | 1.5500 | 0.0001 |
MELD, per 1 point | 1.1200 | 1.1100 | 1.1400 | < 0.0001 |
MELD ≥ 18 | 2.8309 | 2.3151 | 3.4616 | < 0.0001 |
MELD ≥ 26 | 2.5241 | 1.8162 | 3.5080 | < 0.0001 |
Etiology of Cirrhosis | 1.2900 | 1.1300 | 1.4600 | < 0.0001 |
NASH | 0.8300 | 0.6800 | 1.0100 | 0.0636 |
Hepatitis C | 1.0700 | 0.8800 | 1.3100 | 0.5049 |
Alcohol | 1.5600 | 1.2700 | 1.9100 | < 0.0001 |
History of prior TIPS | 1.1500 | 0.8000 | 1.6500 | 0.4422 |
Binary Time-Dependent Variable | ||||
Incidentaloma Discovered | 1.3126 | 1.0858 | 1.5869 | 0.0050 |
HR | 2.5% | 97.5% | p value | |
---|---|---|---|---|
Age, per 1 year | 1.0060 | 0.9983 | 1.0139 | 0.1277 |
Male Sex | 1.0948 | 0.9095 | 1.3178 | 0.3384 |
BMI, per 1 kg/m2 | 0.9973 | 0.9833 | 1.0166 | 0.7110 |
White | 0.9540 | 0.7241 | 1.2570 | 0.7380 |
Hispanic/Latino | 1.3141 | 0.9436 | 1.8302 | 0.1060 |
History of Moderate Alcohol Use | 1.0178 | 0.8052 | 1.2865 | 0.8827 |
Ever smoked | 1.1609 | 0.9656 | 1.3956 | 0.1125 |
MELD, per 1 point | 1.1219 | 1.1060 | 1.1380 | < 0.001 |
NASH | 0.9365 | 0.7464 | 1.1751 | 0.5712 |
History of prior TIPS | 0.8839 | 0.6120 | 1.2766 | 0.5106 |
Binary Time-Dependent Variable | ||||
Incidentaloma Discovered | 1.2975 | 1.0679 | 1.5763 | 0.0088 |
Extrahepatic incidentalomas
Patients with Incidentalomas, N = 574 | Total, % |
---|---|
Total number of Incidentalomas | 690 |
Patients with multiple incidentalomas | 106 (18.5%) |
Types of incidentalomas | |
Kidney | 420 (60.9%) |
Pancreas | 208 (30.1%) |
Spleen | 25 (3.6%) |
Adrenal | 11 (1.6%) |
Gallbladder | 11 (1.6%) |
Pelvic | 9 (1.3%) |
Bone | 4 (0.6%) |
Stomach | 2 (0.3%) |
Number of incidentalomas undergoing biopsy/resection | 16 (2.3%) |
Pancreas | 7 (47.1%) |
Kidney | 3 (17.6%) |
Gallbladder | 4 (23.5%) |
Pelvis | 1 (5.9%) |
Stomach | 1 (5.9%) |
Number of malignancies detected | 7 (1.0%) |
Gastric Neuroendocrine Tumor | 1 (14.3%) |
Cholangiocarcinoma | 2 (28.6%) |
Renal cell carcinoma | 3 (42.9%) |
Pancreatic adenocarcinoma | 1 (14.3%) |
Management of incidentalomas | |
Observation | 682 (98.8%) |
Surgery, alone | 5 (0.7%) |
Chemotherapy/Radiation, alone | 2 (0.3%) |
Surgery and Chemotherapy/Radiation | 1 (0.1%) |
Incidentaloma, N = 690 | Total, % |
---|---|
Kidney or Pancreatic | 628 (91.0%) |
Kidney | 420 |
Type of Lesion | |
Simple Cyst | 417 (99.3%) |
Solid Lesion | 3 (0.7%) |
Size of Lesion | |
< 1 cm | 396 (94.3%) |
[1,3) cm | 15 (3.6%) |
[3, 5) cm | 3 (0.7%) |
≥ 5 cm | 6 (1.4%) |
Referred to Urology | 5 (1.2%) |
Pancreas | 208 |
Type of Lesion | |
IPMN, Cystic Lesion | 207 (99.5%) |
Solid Lesion | 1 (0.5%) |
Size of Lesion | |
< 1 cm | 169 (81.3%) |
[1,3) cm | 36 (17.3%) |
[3, 5) cm | 2 (1.0%) |
≥ 5 cm | 1 (0.5%) |
Referred to Gastroenterology | 109 (52.4%) |
Underwent EUS | 12 (5.8%) |
MRI Findings | CA 19–9 (U/mL) | EUS Findings | Biopsy | Pathology |
---|---|---|---|---|
Numerous subcentimeter non-enhancing cysts, likely side-branch IPMNs | N/A | Mild-moderate chronic pancreatitis | No | N/A |
1.4 × 2.2 cm cystic lesion at pancreatic head, likely IPMN | 105 | Multicystic, septated, 22 × 15 mm lesion | Yes | Malignancy absent, mucinous epithelium |
Multilobulated pancreatic tail cystic lesion, 2.4 × 2.9 cm | N/A | Septated lesion, 28 mm, side-branch IPMN | Yes | Malignancy absent, mucinous epithelium |
Parenchymal atrophy, innumerable tiny cysts; irregular main duct | N/A | Many benign cysts in tail; largest 7 mm | No | N/A |
3.3 × 2.3 cm septated cystic lesion at pancreatic neck | 6 | Multiloculated 2.75 × 1.98 cm cyst at neck | Yes | Malignancy absent, mucinous epithelium |
Numerous unilocular cysts at head, largest 14 mm | 255 | 12 × 10 mm cyst in pancreatic head | Yes | Malignancy absent, mucinous epithelium |
1.7 cm hypoenhancing head mass | 103 | 1.7 cm pancreatic head mass | Yes | Adenocarcinoma |
3 mm cystic lesion at uncinate process | N/A | 8 × 8 mm uncinate cystic lesion | No | N/A |
Few sub-5 cm cystic foci in pancreas | 44 | Few cysts in the pancreatic head | No | N/A |
7–8 mm enhancing lesion at uncinate process, suspicious for NET | 35 | Multiple cystic lesions at uncinate, 10 × 10 mm | Yes | Malignancy absent, mucinous epithelium |
Small cystic lesions, likely side-branch IPMNs | 29 | Pancreatic head cysts, 3 × 3 mm, no mass | No | N/A |
Small cystic lesions, largest is 8 × 12 mm, likely IPMN | N/A | 25 × 17 mm pancreatic head cystic lesion | Yes | Malignancy absent, mucinous epithelium |
Incidental Finding | Size | Pathology | Treatment | Transplanted |
---|---|---|---|---|
Gastric solid lesion | < 1 cm | Well-differentiated NET | EMR, Cured | No |
Gallbladder solid lesion | 1–3 cm | Cholangiocarcinoma | Chemoradiation, Died | No |
Renal solid lesion | > 5 cm | Renal cell carcinoma, clear cell | Nephrectomy, Cured | Yes |
Gallbladder solid lesion | 1–3 cm | Cholangiocarcinoma | Neoadjuvant Chemotherapy, Cured with transplantation | Yes |
Renal solid lesion | 1–3 cm | Renal cell carcinoma, papillary | Nephrectomy, Cured | Yes |
Renal solid lesion | < 1 cm | Renal cell carcinoma, clear cell | Nephrectomy, Cured | Yes |
Pancreatic solid lesion | 1–3 cm | Pancreatic adenocarcinoma | Chemotherapy and Surgery, Cured | No |