Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Dec;19(12):1343-53.
doi: 10.1002/lt.23753.

Identification of liver transplant candidates with hepatocellular carcinoma and a very low dropout risk: implications for the current organ allocation policy

Neil Mehta  1 , Jennifer L Dodge, Aparna Goel, John Paul Roberts, Ryutaro Hirose, Francis Y Yao
Affiliations

Identification of liver transplant candidates with hepatocellular carcinoma and a very low dropout risk: implications for the current organ allocation policy

Neil Mehta et al. Liver Transpl. 2013 Dec.

Abstract

It has been shown that patients with hepatocellular carcinoma (HCC) meeting the United Network for Organ Sharing T2 (Milan) criteria have an advantage in comparison with patients without HCC under the current organ allocation system for liver transplantation (LT). We hypothesized that within the T2 HCC group, there is a subgroup with a low risk of wait-list dropout that should not receive the same listing priority. This study evaluated 398 consecutive patients with T2 HCC listed for LT with a Model for End-Stage Liver Disease exception from March 2005 to January 2011 at our center. Competing risk (CR) regression was used to determine predictors of dropout. The probabilities of dropout due to tumor progression or death without LT according to the CR analysis were 9.4% at 6 months and 19.6% at 12 months. The median time from listing to LT was 8.8 months, and the median time from listing to dropout or death without LT was 7.2 months. Significant predictors of dropout or death without LT according to a multivariate CR regression included 1 tumor of 3.1 to 5 cm (versus 1 tumor of 3 cm or less), 2 or 3 tumors, a lack of a complete response to the first locoregional therapy (LRT), and a high alpha-fetoprotein (AFP) level after the first LRT. A subgroup (19.9%) that met certain criteria (1 tumor of 2 to 3 cm, a complete response after the first LRT, and an AFP level ≤ 20 ng/mL after the first LRT) had 1- and 2-year probabilities of dropout of 1.3% and 1.6%, respectively, whereas the probabilities were 21.6% and 26.5% for all other patients (P = 0.004). In conclusion, a combination of tumor characteristics and a complete response to the first LRT define a subgroup of patients with a very low risk of wait-list dropout who do not require the same listing priority. Our results may have important implications for the organ allocation policy for HCC.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative incidence of waitlist dropout due to tumor progression or death by (A). Tumor size (B). Response to first loco-regional therapy received based on modified RECIST criteria and (C). Alpha-fetoprotein after first loco-regional therapy received.
Figure 1
Figure 1
Cumulative incidence of waitlist dropout due to tumor progression or death by (A). Tumor size (B). Response to first loco-regional therapy received based on modified RECIST criteria and (C). Alpha-fetoprotein after first loco-regional therapy received.
Figure 1
Figure 1
Cumulative incidence of waitlist dropout due to tumor progression or death by (A). Tumor size (B). Response to first loco-regional therapy received based on modified RECIST criteria and (C). Alpha-fetoprotein after first loco-regional therapy received.
Figure 2
Figure 2
The cumulative incidence of waitlist dropout due to tumor progression or death by dropout risk groups (competing risks). The low-risk group (L-DOR) meets the following criteria: a single tumor 2–3cm, a complete response to first loco-regional therapy, and an alpha-fetoprotein ≤20 ng/ml after first loco-regional therapy received.
See this image and copyright information in PMC

Comment in

References

    1. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–470. - PubMed
    1. Wiesner RH, McDiarmid SV, Kamath PS, et al. MELD and PELD. Application of survival models to liver allocation. Liver Transpl. 2001;7:567–580. - PubMed
    1. Freeman RB, Jr, Wiesner RH, Harper A, et al. The new liver allocation system: Moving towards evidence-based transplantation policy. Liver Transpl. 2002;8:851–858. - PubMed
    1. Yao FY, Bass NM, Nikolai B, Merriman R, Davern TJ, Kerlan R, 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. Liver Transpl. 2003;9:684–692. - PubMed
    1. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. for United Network for Organ Sharing Liver Disease Severity Score Committee. Model for End-stage Liver Disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91–96. - PubMed

Publication types

MeSH terms