Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy

Wiesner, Russell H.; Freeman, Richard B.; Mulligan, David C.

doi:10.1053/j.gastro.2004.09.040

Cited by 259 publications

(207 citation statements)

References 36 publications

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“…In Hayashi et al's study, 4 there was no evidence of a tumor in the explanted liver for 8 of 30 patients (27%) with a pretransplant diagnosis of HCC, and this led to incorrect organ allocation for 7% of their patients. Wiesner et al 5 reported that for 31% of their patients who underwent liver transplantation for stage 1 HCC (1 nodule 19 mm) and for 9% of their patients who underwent liver transplantation for stage 2 HCC (1 nodule of 20-50 mm or 2-3 nodules with all 30 mm), there was no evidence of a tumor in the explanted liver. Similar results were also reported in a recent study from France: a false-positive preoperative diagnosis of HCC was made for 20% of the patients.…”

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confidence: 99%

Is tumor biopsy necessary?

et al. 2011

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Is tumor biopsy necessary?

et al. 2011

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“…1 Currently, patients with small hepatocellular carcinoma lesions confined to the liver are given priority on the United Network for Organ Sharing (UNOS) liver transplant waiting list and 14% of cadaveric donor liver transplants are performed in patients with hepatocellular carcinoma. 2 The risk of recurrence is the major concern in patients transplanted for hepatocellular carcinoma. Clinical features that have been associated with recurrence after resection or liver transplantation include the size and number of tumor nodules, micro/macrovascular invasion and high serum alpha feto-protein (AFP) levels.…”

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p53, Ki-67, and serum alpha feto-protein as predictors of hepatocellular carcinoma recurrence in liver transplant patients

et al. 2005

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Patients with hepatocellular carcinoma who undergo orthotopic liver transplantation (OLT) are at risk for posttransplant tumor recurrence. The aim of this study was to evaluate whether expression of p53 and Ki-67 in hepatocellular carcinoma lesions present in explanted liver tissue was associated with time to tumor recurrence after OLT. Subjects consisted of 20 consecutive patients who underwent OLT and were found to have hepatocellular carcinoma in the liver explant. Immunostaining for p53 and Ki-67 was performed by standard methods. The presence of nuclear immunostaining in 410% of the tumor tissue was considered positive. Time to recurrence of hepatocellular carcinoma after OLT was compared between patients with positive and negative immunostaining by the log rank test. Multivariate analysis was performed using a Cox regression model to control for potentially confounding clinical factors. Time to post-transplant hepatocellular carcinoma recurrence was significantly more rapid in p53 þ (P ¼ 0.0007) and Ki-67 þ cases (P ¼ 0.001). These associations remained significant in multivariate analysis. Furthermore, time to recurrent hepatocellular carcinoma was significantly shorter in patients with a serum alpha feto-protein (AFP) level Z100 ng/ml at time of diagnosis, compared to those with an AFP level o100 ng/ml (P ¼ 0.003). In conclusion, expression of p53 and Ki-67 in hepatocellular carcinoma lesions, and a serum AFP level Z100 ng/ml were associated with more rapid recurrence of hepatocellular carcinoma after OLT. Identification of patients at risk for early post-transplant recurrence could be used to guide surveillance and adjuvant treatment strategies.

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“…7,10 Modifications were made to the MELD score after its institution with the goal of making the allocation system fair to patients without HCC. 11 Still, the argument persists that liver transplantation for patients with stage II HCC and Child A cirrhosis results in a very low survival benefit and may not be the optimal use of scarce donor livers. 12 Now, maybe by combining these 2 controversial topics, advanced age and HCC, we can develop recommendations that balance both justice and utility for the elderly patient with HCC who is healthy enough to receive a liver transplant.…”

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Treatment of an elderly patient with hepatocellular carcinoma: Counseling from the patient's point of view

Perkins

2012

Liver Transpl

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Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy

Cited by 259 publications

References 36 publications

Is tumor biopsy necessary?

Is tumor biopsy necessary?

p53, Ki-67, and serum alpha feto-protein as predictors of hepatocellular carcinoma recurrence in liver transplant patients

Treatment of an elderly patient with hepatocellular carcinoma: Counseling from the patient's point of view

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