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Evaluating the validity of model for end‐stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm
Author(s) -
Samoylova Mariya L.,
Dodge Jennifer L.,
Mehta Neil,
Yao Francis Y.,
Roberts John P.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12480
Subject(s) - hepatocellular carcinoma , medicine , liver disease , liver transplantation , stage (stratigraphy) , milan criteria , model for end stage liver disease , gastroenterology , carcinoma , oncology , radiology , transplantation , paleontology , biology
Abstract Liver transplant allocation policy does not give model for end‐stage liver disease (MELD) exception points for patients with a single hepatocellular carcinoma (HCC) <2 cm in size, but does give points to patients with multiple small nodules. Because standard‐of‐care imaging for HCC struggles to differentiate HCC from other nodules, it is possible that a subset of patients receiving liver transplant for multiple nodules <2 cm in size does not have HCC. We evaluate risk of post‐transplant HCC recurrence and wait‐list dropout for patients with multiple small nodules using competing risks regression based on the Fine and Gray model. We identified 5002 adult HCC patients in the OPTN/UNOS dataset diagnosed and transplanted between January 2006 and September 2010. Compared to patients with >1 tumor <2 cm, risk of developing recurrence was significantly higher in patients with one or more tumors with only one tumor ≥2 cm (SHR 1.63, p = 0.009), as well as in patients with 2–3 tumors ≥2 cm (SHR 1.84, p = 0.02). Dropout risk was not significantly different among size categories. HCC recurrence risk was significantly lower in patients with multiple nodules <2 cm in size than in those with larger tumors, supporting the possibility that some patients received unnecessary transplants. The priority given to these patients must be re‐examined.