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

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 = 0.027). Prolonged time on the list significantly reduced mortality in this analysis (p = 0.02, HR = 0.28). Model for End Stage Liver Disease (MELD) score at transplantation did also independently impact overall survival (p = 0.03, HR = 1.06). MELD was the only factor that independently impacted posttransplant survival (p = 0.048, HR = 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.

[1]  Yiyi Chen,et al.  Waiting time predicts survival after liver transplantation for hepatocellular carcinoma: A cohort study using the United Network for Organ Sharing registry , 2014, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[2]  Massimo Rossi,et al.  Alpha‐fetoprotein and modified response evaluation criteria in Solid Tumors progression after locoregional therapy as predictors of hepatocellular cancer recurrence and death after transplantation , 2013, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[3]  P. Salvalaggio,et al.  A proposal to grade the severity of early allograft dysfunction after liver transplantation , 2013, Einstein.

[4]  M. Kudo,et al.  Consensus recommendations and review by an International Expert Panel on Interventions in Hepatocellular Carcinoma (EPOIHCC) , 2013, Liver international : official journal of the International Association for the Study of the Liver.

[5]  H. Hussain,et al.  New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. , 2013, Radiology.

[6]  P. Salvalaggio,et al.  The MELD system and liver transplant waiting-list mortality in developing countries: lessons learned from São Paulo, Brazil. , 2012, Einstein.

[7]  J. Bruix,et al.  Screening for hepatocellular carcinoma: The rationale for the American Association for the Study of Liver Diseases recommendations , 2012, Hepatology.

[8]  R. Hirose,et al.  Risk factors for liver transplant waitlist dropout in patients with hepatocellular carcinoma , 2012, Clinical transplantation.

[9]  B. French,et al.  Increasing disparity in waitlist mortality rates with increased model for end‐stage liver disease scores for candidates with hepatocellular carcinoma versus candidates without hepatocellular carcinoma , 2012, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[10]  M. Negrini,et al.  292 IN HEPATOCELLULAR CARCINOMA MIR-519D IS UPREGULATED BY P53 AND DNA HYPOMETHYLATION , 2012 .

[11]  P. Morel,et al.  The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma. , 2011, Journal of hepatology.

[12]  T. Livraghi,et al.  Tools for monitoring patients with hepatocellular carcinoma on the waiting list and after liver transplantation , 2011, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[13]  N. Girard,et al.  Is the treatment of hepatocellular carcinoma on the waiting list necessary? , 2011, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[14]  K. Washburn,et al.  Hepatocellular carcinoma and liver transplantation , 2011, Current opinion in organ transplantation.

[15]  D. Raptis,et al.  The model for end‐stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis , 2011, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[16]  A. Venook,et al.  Hepatocellular carcinoma: Ablate and wait versus rapid transplantation , 2010, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[17]  R. Freeman,et al.  Hepatocellular Carcinoma Patients Are Advantaged in the Current Liver Transplant Allocation System , 2010, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[18]  Riccardo Lencioni,et al.  Modified RECIST (mRECIST) Assessment for Hepatocellular Carcinoma , 2010, Seminars in liver disease.

[19]  J. Marrero,et al.  An intention‐to‐treat analysis of liver transplantation for hepatocellular carcinoma using organ procurement transplant network data , 2009, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[20]  R. Freeman.  Model for end‐stage liver disease (MELD) for liver allocation: A 5‐year score card , 2008, Hepatology.

[21]  M. Farr,et al.  Short Waitlist Time Does Not Adversely Impact Outcome Following Liver Transplantation for Hepatocellular Carcinoma , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[22]  W. Jaschke,et al.  Response to preoperative chemoembolization correlates with outcome after liver transplantation in patients with hepatocellular carcinoma , 2007, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[23]  R. Wiesner,et al.  Model for end‐stage liver disease (MELD) exception guidelines , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[24]  R. Wiesner,et al.  Reduced Priority MELD Score for Hepatocellular Carcinoma Does Not Adversely Impact Candidate Survival Awaiting Liver Transplantation , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[25]  G. Otto,et al.  Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[26]  R. Freeman,et al.  Waiting List Removal Rates Among Patients with Chronic and Malignant Liver Diseases , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[27]  J. Bragg-Gresham,et al.  Characteristics Associated with Liver Graft Failure: The Concept of a Donor Risk Index , 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[28]  M. Abecassis,et al.  Living donor liver transplantation for hepatocellular carcinoma. , 2004, Gastroenterology.

[29]  R. Wiesner,et al.  Liver transplantation for hepatocellular carcinoma: The MELD impact , 2004, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[30]  T. Davern,et al.  A follow‐up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: Implications for the current organ allocation policy , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[31]  L Pagliaro,et al.  Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. , 2001, Journal of hepatology.

[32]  F. Bray,et al.  Cancer burden in the year 2000. The global picture. , 2001, European journal of cancer.

[33]  ndrea,et al.  Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. , 1996, The New England journal of medicine.

[34]  N. Chavez-Tapia,et al.  Clinical practice guidelines: Management of Hepatocellular Carcinoma , 2014 .

[35]  V. Mazzaferro,et al.  EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma European Association for the Study of the Liver ⇑ , European Organisation for Research and Treatment of Cancer , 2012 .