{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:40:02Z","timestamp":1782139202333,"version":"3.54.5"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,2,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Liver cancer (LC) is a serious late complication after the Fontan operation. However, the incidence, predictors, and prognosis remain unknown. The purpose of our study was to determine these clinical characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We assessed liver function in 339 consecutive patients who had undergone the Fontan procedure from 2005 to 2019. LC was histologically diagnosed in 10 patients after a median period of 2.9\u00a0years (range: 0.3\u201313.8; median age: 29.9\u00a0years [range: 14.4\u201341.5\u00a0years]; overall median post\u2013Fontan procedure follow\u2010up: 25.6\u00a0years [range: 13\u201332.1\u00a0years]), and the annual incidence was 0.89%. Over the entire post\u2010Fontan follow\u2010up period, the annual incidences of new\u2010onset LC in the second, third, and fourth decades were 0.14%, 0.43%, and 8.83%, respectively. The patients with LC had longer follow\u2010up periods, higher levels of AFP (\u03b1\u2010fetoprotein), and higher values of liver fibrosis indices (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01\u20130.0001). Moreover, all indices were predictive of new\u2010onset LC (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01\u20130.0001). The LC treatments were surgical resection (n=3), transarterial chemoembolization (n=3), radiofrequency ablation (n=2), and hospice care (n=2). During a median follow\u2010up of 9.4\u00a0months, 4 patients died; the survival rate at 1\u00a0year was 60%, and it was better among asymptomatic patients (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The LC incidence rapidly increased \u226530\u00a0years after the Fontan procedure, and liver fibrosis indices and AFP were predictive of new\u2010onset LC. These LC\u2010predictive markers should be monitored closely and mandatorily for early LC detection and better prognosis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.016617","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T10:32:13Z","timestamp":1612434733000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Incidence, Predictors, and Mortality in Patients With Liver Cancer After Fontan Operation"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7092-4792","authenticated-orcid":false,"given":"Hideo","family":"Ohuchi","sequence":"first","affiliation":[{"name":"Pediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka Japan"},{"name":"Adult Congenital Heart Disease National Cerebral and Cardiovascular Center Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3836-2333","authenticated-orcid":false,"given":"Yohsuke","family":"Hayama","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimiko","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Kurosaki","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isao","family":"Shiraishi","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology National Cerebral and Cardiovascular Center Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michikazu","family":"Nakai","sequence":"additional","affiliation":[{"name":"Center for Cerebral and Cardiovascular Disease Information National Cerebral and Cardiovascular Center Suita Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.09.002"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.007764"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.045"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.032717"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2017.03.020"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50346"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"e_1_3_1_9_2","first-page":"986","article-title":"Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model","volume":"36","author":"Forns X","year":"2002","unstructured":"Forns X, Ampurdan\u00e8s S, Llovet JM, Aponte J, Quint\u00f3 L, Mart\u00ednez\u2010Bauer E, Bruguera M, S\u00e1nchez\u2010Tapias JM, Rod\u00e9s J. 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