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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
Author(s) -
Yao Francis Y.,
Bass Nathan M.,
Nikolai Bev,
Merriman Raphael,
Davern Timothy J.,
Kerlan Robert,
Ascher Nancy L.,
Roberts John P.
Publication year - 2003
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 - 10.1053/jlts.2003.50147
Subject(s) - medicine , dropout (neural networks) , hepatocellular carcinoma , liver transplantation , lesion , cohort , interim analysis , transplantation , liver cancer , surgery , radiology , randomized controlled trial , machine learning , computer science
Since our interim report of the intention‐to‐treat outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), we have performed a follow‐up analysis of an expanded cohort of 70 patients to further assess whether the observed pattern and predictors of dropout are consistent with the rationale behind current HCC‐adjusted Model for End Stage Liver Disease (MELD) organ allocation scheme. All except one patient had pretransplantation staging meeting our proposed expanded criteria—a single lesion ≤6.5 cm, or three or fewer lesions none >4.5 cm and total tumor diameter ≤8 cm. Thirty‐eight patients received OLT. The cumulative probabilities of dropout at 6, 12, and 18 months were 7.2%, 37.8%, and 55.1%, respectively. The respective dropout probabilities would have been 11.0%, 57.4%, and 68.7% if the United Network for Organ Sharing (UNOS) criteria for exclusion (single lesion ≤5 cm or three or fewer lesions none >3 cm) were applied. Predictors of dropout with either criteria included three tumor nodules and a single lesion >3 cm at initial presentation, whereas preoperative chemoembolization or ablation therapies were associated with a lower risk for dropout only when applying the UNOS criteria for patient exclusion. In the subgroup with two or three lesions or a solitary tumor >3 cm, the cumulative probabilities of dropout were nine‐fold higher than those with a single lesion ≤3cm ( P = .004). In conclusion, the low dropout rate in the first 6 months and the differing dropout risks based on tumor characteristics support further refinements in the HCC‐adjusted MELD organ allocation scheme. ( Liver Transpl 2003;9:684‐692. )