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Title
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Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the eurotransplant allocation system
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Author
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Abstract
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| Although hepatocellular carcinoma (HCC) has become a recognized indication for liver transplantation, the rules governing priority and access to the waiting list are not well defined. Patient- and tumor-related variables were evaluated in 226 patients listed primarily for HCC in Belgium, a region where the allocation system is patient-driven, priority being given to sicker patients, based on the Child-Turcotte-Pugh (CTP) score, Intention-to-treat and posttransplantation survival rates at 4 years were 56.5 and 66%, respectively, and overall HCC recurrence rate was 10%. The most significant predictors of failure to receive a transplant in due time were baseline CTP score equal to or above 9 (relative risk [RR] 4.1; confidence interval [Cl]: 1.7-9.9) and a fetoprotein above 100 ng/mL (RR 3.0; Cl: 1.2-7.1). Independent predictors of posttransplantation mortality were age equal to or above 50 years (RR 2.5; Cl: 1.0-3.7) and United Network for Organ Sharing pathological tumor nodule metastasis above the Milan criteria (RR 2.1; Cl: 1.0-5.9). Predictors of recurrence (10%) were a fetoprotein above 100 ng/mL (RR 3.2; Cl:1.1-10) and vascular involvement of the tumor on the explant (RR 3.6; Cl: 1.1-11.3). Assessing the value of the pretransplantation staging by imaging compared to explant pathology revealed 34% accuracy, absence of carcinoma in 8.3%, overstaging in 36.2%, and understaging in 10.4%. Allocation rules for HCC should consider not only tumor characteristics but also the degree of liver impairment. Patients older than 50 years with a stage above the Milan criteria at transplantation have a poorer prognosis after transplantation. |
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Language
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English
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Source (journal)
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Liver transplantation. - Philadelphia, Pa
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Source (book)
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41st Annual Meeting of the, European-Association-for-the-Study-of-the-Liver, APR 26-30, 2006, Vienna, AUSTRIA
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Publication
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Philadelphia, Pa
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2008
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ISSN
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1527-6465
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DOI
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10.1002/LT.21399
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Volume/pages
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14
:4
(2008)
, p. 526-533
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ISI
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000254724100019
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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