Can we direct organ allocation based on predicted outcome? Hepatocellular carcinoma outside of UCSF criteria or retransplant?

Rochon, Caroline; Sheiner, Patricia A.; Mahadevappa, Basant; Gunasekaran, Ganesh; Sharma, Joyti; Wolf, David C.; Facciuto, Marcelo

doi:10.1007/s00423-012-0910-3

Cited by 1 publication

(2 citation statements)

References 16 publications

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“… 8 , 9 , 11 , 12 , 24 The presented survival outcomes of high-risk HCC patients are even lower than that reported in the literature for patients beyond the Milan criteria, presumably due to more liberal selection policy applied in the authors department reducing selection bias. 5 , 7 , 12 , 25 , 26 The outcomes of high-MELD non-HCC patients seem comparable to that previously reported. 24 Although survival of HCC patients in general and, in particular, that of high-risk HCC patients was significantly inferior to that observed for the entire cohort of non-HCC patients, the outcomes were similar in HCC and non-HCC patients belonging to low-, moderate-, and high-risk subgroups.…”

Section: Discussionsupporting

confidence: 85%

“…Apart from HCC and high MELD scores, several other conditions are reported to be associated with particularly poor posttransplant outcomes resembling that of the highest-risk HCC patients, such as retransplantation for hepatitis C virus recurrence, trauma, and unresectable neuroendocrine tumors metastases. 25 , 30 , 31 Considering survival benefit, it is the high-risk HCC patients and non-HCC patients that are reported to benefit most from undergoing LT. 18 , 32 , 33 However, pretransplant alpha-fetoprotein was previously found to be inversely correlated with transplant benefit. 34 Therefore, potential expansion of the selection criteria into patients with high alpha-fetoprotein should be considered with great caution considering both transplant utility and benefit.…”

Section: Discussionmentioning

confidence: 99%

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Challenging the principle of utility as a barrier for wider use of liver transplantation for hepatocellular cancer

et al. 2017

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Background. Although transplant benefit appears superior for patients with advanced hepatocellular cancer (HCC), liver transplantation remains limited to selected low-risk HCC patients to keep their outcomes similar to heterogeneous group of non-HCC patients. The purpose of this study was to assess the rationale for current policy of restricting access to liver transplantation to minority of HCC patients based on utility principle. Methods. This retrospective cohort study comprised 1246 liver transplant recipients, including 206 HCC and 1040 non-HCC patients. Patient survival was the primary outcome measure. Patients with HCC and benign diseases were divided into low-, moderate-, and high-risk subgroups basing on independent risk factors for disease-free survival and model for end-stage liver disease (MELD) score (\30, 30-40, [40), respectively. Results. MELD (p \ 0.001) and presence of HCC (p = 0.008) were independent risk factors for early and late mortality, respectively. Total tumor volume (p = 0.008) and alpha-fetoprotein (p = 0.013) were independent predictors of recurrence and mortality used for division of HCC patients into low-, moderate-, and highrisk subgroups, with disease-free survival rates of 74.9% (5 years), 51.7% (5 years), and 8.0% (3 years), respectively (p \ 0.001). There were no differences in 5-year overall survival between low-risk HCC (74.9%) and non-HCC (81.9%) patients (p = 0.210), moderate-risk HCC (63.3%) and non-HCC (68.0%) patients (p = 0.372), and high-risk HCC (55.0%) and non-HCC (56.0%) patients (p = 0.559). Conclusions. The principle of utility is unequally applied for restriction of access to liver transplantation for HCC patients. The results provide rationale for discussion on reinitiation of liver transplantation for advanced HCCs.

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