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. 2015 Jan;29(1):52-9.
doi: 10.1111/ctr.12480. Epub 2014 Dec 1.

Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm

Mariya L Samoylova  1 , Jennifer L Dodge, Neil Mehta, Francis Y Yao, John P Roberts
Affiliations

Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm

Mariya L Samoylova et al. Clin Transplant. 2015 Jan.

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.

Keywords: hepatocellular carcinoma; liver transplant; recurrence; small nodules.

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Conflict of interest statement

Conflict of interest: None reported.

Figures

Figure 1
Figure 1
Cumulative incidence, 95% confidence intervals, and number at risk for hepatocellular carcinoma recurrence by tumor load.
See this image and copyright information in PMC

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