List and Liver Transplant Survival According to Waiting Time in Patients With Hepatocellular Carcinoma

Abstract

The time that patients with hepatocellular carcinoma (HCC) can safely remain on the waiting list for liver transplantation (LT) is unknown. We investigated whether waiting time on the list impacts transplant survival of HCC candidates and transplant recipients. This is a single-center retrospective study of 283 adults with HCC. Patients were divided in groups according to waiting-list time. The main endpoint was survival. The median waiting time for LT was 4.9 months. The dropout rates at 3-, 6-, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Mortality on the list was 4.8%, but varied depending of the time on the list. Patients who waited less than 3-months had an inferior overall survival when compared to the other groups (p ¼ 0.027). Prolonged time on the list significantly reduced mortality in this analysis (p ¼ 0.02, HR ¼ 0.28). Model for End Stage Liver Disease (MELD) score at transplantation did also independently impact overall survival (p ¼ 0.03, HR ¼ 1.06). MELD was the only factor that independently impacted posttransplant survival (p ¼ 0.048, HR ¼ 1.05). We conclude that waiting time had no relation with posttransplant survival. It is beneficial to prolong the waiting list time for HCC candidates without having a negative impact in posttransplant survival.

The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: A prospective validation study

“…This perspective is important from the patient's point of view and in understanding effectiveness because the time spent on the WL tends to exclude patients with unfavorable tumor biology who tend to have tumor progression that disqualifies them while waiting. (31,32) Our data support this premise as the dropout rates were significantly higher in patients with M1 tumors, even with the relatively short wait times as found in our patient population (median time to transplant 5 4.2 months).…”

Wait Time of Less Than 6 and Greater Than 18 Months Predicts Hepatocellular Carcinoma Recurrence After Liver Transplantation

“…Finally, we have not yet validated the wait time “sweet spot”. A single-center study attempted to identify the “optimal” wait time for LT in HCC patients using an intention-to-treat survival analysis 38 , but we are concerned about the statistical bias as wait time itself is part of the observation. For example, a patient must survive 6 months from HCC diagnosis to be in the 6–18-month wait time group and patients dying within 3 months of diagnosis would automatically be included in the <3-month wait time group.…”

Resection or Transplant in Early Hepatocellular Carcinoma

“…These patients can be treated immediately. In addition, approximately 5 to 25% of those added to an organ transplant waiting list for HCC were removed from the list within a year (18). In these patients, although they were originally suitable to be organ recipients, HCC progressed swiftly despite bridging therapy.…”

“…However, the survival rates of patients who received liver transplant particularly quickly were worse than those of patients who survived for 6 to 12 months of bridging therapy. Multivariate analysis showed no adverse effect for a longer waiting time (18). Some publications even found that waiting time could be used as an important selection criterion (known as the "test of time") (19)(20)(21).…”