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. 2019 Aug;19(8):2210-2218.
doi: 10.1111/ajt.15353. Epub 2019 Apr 5.

Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation

Neil Mehta  1 , Jennifer L Dodge  2 , Ryutaro Hirose  2 , John P Roberts  2 , Francis Y Yao  1   2
Affiliations

Predictors of low risk for dropout from the liver transplant waiting list for hepatocellular carcinoma in long wait time regions: Implications for organ allocation

Neil Mehta et al. Am J Transplant. 2019 Aug.

Abstract

All patients with hepatocellular carcinoma meeting United Network for Organ Sharing T2 criteria currently receive the same listing priority for liver transplant (LT). A previous study from our center identified a subgroup with a very low risk of waitlist dropout who may not derive immediate LT benefit. To evaluate this issue at a national level, we analyzed within the United Network for Organ Sharing database 2052 patients with T2 hepatocellular carcinoma receiving priority listing from 2011 to 2014 in long wait time regions 1, 5, and 9. Probabilities of waitlist dropout were 18.3% at 1 year and 27% at 2 years. In multivariate analysis, factors associated with a lower risk of waitlist dropout included Model for End-Stage Liver Disease-Na < 15, Child's class A, single 2- to 3-cm lesion, and α-fetoprotein ≤20 ng/mL. The subgroup of 245 (11.9%) patients meeting these 4 criteria at LT listing had a 1-year probability of dropout of 5.5% vs 20% for all others (P < .001). On explant, the low dropout risk group was more likely to have complete tumor necrosis (35.5% vs 24.9%, P = .01) and less likely to exceed Milan criteria (9.9% vs 17.7%, P = .03). We identified a subgroup with a low risk of waitlist dropout who should not receive the same LT listing priority.

Keywords: Organ Procurement and Transplantation Network (OPTN); United Network for Organ Sharing (UNOS); clinical research/practice; health services and outcomes research; liver disease malignant; liver transplantation/hepatology; organ allocation; organ procurement and allocation; recipient selection.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of liver transplant (LT) and waitlist dropout due to tumor progression, being too sick to undergo LT, or death
FIGURE 2
FIGURE 2
Cumulative incidence of waitlist dropout due to tumor progression, being too sick to undergo livertransplant, or death by listing characteristics. A, MELD-Na < 15 vs ≥ 15. B, Child-Pugh class. C, Tumor size. D, α-Fetoprotein ≤20 vs >20 ng/mL
FIGURE 3
FIGURE 3
Cumulative incidence of waitlist dropout with low-risk group meeting all of the following at listing: MELD-Na < 15, Child-Pugh class A, single tumor 2–3 cm, and AFP ≤20 ng/mL
See this image and copyright information in PMC

Comment in

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