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Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the Eurotransplant allocation system
Author(s) -
Adler Michael,
De Pauw Filip,
Vereerstraeten Pierre,
Fancello Agnese,
Lerut Jan,
Starkel Peter,
Van Vlierberghe Hans,
Troisi Roberto,
Donckier Vincent,
Detry Olivier,
Delwaide Jean,
Michielsen Peter,
Chapelle Thierry,
Pirenne Jacques,
Nevens Frederik
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21399
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , milan criteria , pathological , confidence interval , transplantation , relative risk , metastasis , carcinoma , surgery , cancer
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 [CI]: 1.7–9.9) and α fetoprotein above 100 ng/mL (RR 3.0; CI: 1.2–7.1). Independent predictors of posttransplantation mortality were age equal to or above 50 years (RR 2.5; CI: 1.0–3.7) and United Network for Organ Sharing pathological tumor nodule metastasis above the Milan criteria (RR 2.1; CI: 1.0–5.9). Predictors of recurrence (10%) were α fetoprotein above 100 ng/mL (RR 3.2; CI:1.1–10) and vascular involvement of the tumor on the explant (RR 3.6; CI: 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. Liver Transpl 14:526–533, 2008. © 2008 AASLD.