Recurrent hepatocellular carcinoma: comparison between repeat hepatectomy and local ablation

Abstract

Aims: Liver transplantation is universally accepted as the treatment of choice for patients with end-stage chronic liver disease and acute liver failure. The overall 1 year survival rates are exceeding 90%. Set up transplant procedures are being cancelled due to various factors, which causes distress to patients and burden to the healthcare system. The objective of this study to evaluate, the eventual outcomes of patients in the transplant operation was set up and cancelled at least once, within a pre-defined study period. Methods: Data was collated from a transplant database held at the Queen Elizabeth Hospital Birmingham and all transplants set up and cancelled between January 2012 and December 2013 was reviewed. Total cancellation episodes, number of times each patient cancelled, reason for cancellation, eventual outcome of those patients after the cancellation were recorded. Results: There were total of 259 episodes of cancellation of liver transplants involving 158 patients. The reason for cancellations were, Donor related 43% (112), graft related 33% (88), recipient related 11% (28), logistics 10% ( 27) and there were no records found for 2% (4) cancellations. The main donor related factor was DCD donors who did not progress. 128 (81%) patients were eventually transplanted. Total of 18 (13%) patients were removed from the list and 8 (5%) patients died whilst on the list. Among these 26 patients, 14 patients (8.8%) would have survived if the set up transplants went ahead, as their transplants were cancelled due to non-recipient factors. Conclusions: Whilst the majority of patients who had their liver transplantation cancelled, eventually got transplanted however, for nearly 9% patient, this was a lost opportunity. Cancelled liver transplants may carry a significant burden to the patients and families and alternative ways of managing patients when chosen for marginal grafts that are unlikely to go ahead should be explored.