Proposal of a novel MELD exception point system for hepatocellular carcinoma based on tumor characteristics and dynamics

Bhat, Mamatha; Ghali, Peter; Dupont, B.; Hilzenrat, Roy; Tazari, Mahmood; Roy, André; Chaudhury, Prosanto; Alvarez, Fernando; Carrier, Michel; Bilodeau, Marc

doi:10.1016/j.jhep.2016.10.008

Cited by 21 publications

(17 citation statements)

References 22 publications

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“…Multiple additional studies further support that the patient in case 1 would have reduced LT survival benefit. (16,(23)(24)(25) For example, Lai et al (23) showed that MELD score ≤13 and tumor burden within Milan criteria decreased the survival benefit of LT, similar to the data from our institution, (26) which showed that patients with a single, small 2-3-cm tumor have a low risk of wait-list dropout. An analysis of the United Network for Organ Sharing (UNOS) database (27) also found that a combination of tumor characteristics (single lesion 2-3 cm and AFP ≤20 ng/mL) and favorable liver function (Child-Pugh A cirrhosis and MELD-Na <15) identifies a subgroup with a low risk of wait-list dropout.…”

Section: Lt Survival Benefitsupporting

confidence: 79%

Hepatocellular Carcinoma—How to Determine Therapeutic Options

Mehta

2020

Hepatol Commun

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Deciding on specific treatment strategies involves not only tumor stage, performance status, and severity of underlying liver disease, but additional factors such as biomarkers, organ availability, and radiographic tumor response to treatment. In this review, we present hepatocellular carcinoma (HCC) cases to highlight how to determine therapeutic options for HCC in specific scenarios, including resection versus liver transplant, choice of initial local regional treatment, tumor downstaging, and systemic therapies for advanced HCC.

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Section: Lt Survival Benefitsupporting

confidence: 79%

Hepatocellular Carcinoma—How to Determine Therapeutic Options

Mehta

2020

Hepatol Commun

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“…431 Novel MELD exception point systems for HCC, based on tumour characteristics and dynamics have been implemented in Europe and America, because of differential post-treatment responses and a risk of drop-out over time. 432,433 This evolution in HCC priority systems, together with the predicted relative increase in cadaveric graft availability due to a reduction in hepatitis C virus (HCV)-related diseases because of direct-acting antiviral treatment, are likely to increase the number of HCC considered for LT in the near future. [434][435][436] The issue must be considered and prospective protocol investigations on HCC transplant patients with HCV are required.…”

Section: Organ Allocation and Priority For Hccmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma

Galle¹,

Forner²,

Llovet³

et al. 2018

Journal of Hepatology

6,293

4,351

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Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma represents about 90% of primary liver cancers and constitutes a major global health problem. The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.

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“…Several attempts have been made to avoid arbitrarily including HCC patients in MELD‐based allocation schemes …”

Section: Is a Tb Model Applicable To Real Life?mentioning

confidence: 99%

“…Several attempts have been made to avoid arbitrarily including HCC patients in MELD-based allocation schemes. (8,13,(25)(26)(27)(28)(29)(30)(31)(32) Most models attempt to equate HCC patients and "biochemical MELD patients" (seeking justice in urgency), considering the dropout risk as the endpoint for HCC patients. These models give higher priority to patients more likely to drop out (Table 1).…”

Section: Hcc Patient Prioritizationmentioning

confidence: 99%