Modest Impact of Liver Transplantation on Hepatocellular Carcinoma Mortality in the United States, Findings from The Transplant Cancer Match (TCM) Study

Abstract

Liver transplantation is considered the most curative treatment for patients with localized hepatocellular carcinoma (HCC). Recent organ allocation policies have reduced the priority of patients with HCC for liver transplantation, which might affect overall liver transplantation usage and HCC-specific mortality among patients with HCC. Therefore, studies on the impact of liver transplantation on population-level HCC-specific mortality rates are necessary and essential. Mahale and colleagues used comprehensive, linked population databases on both HCC cancer cases and liver transplantation recipients and applied incidence-based mortality (IBM) analysis to evaluate the overall impact of liver transplantation on HCC mortality in the United States. Although liver transplantation rates continue to rise in the United States, the authors showed that liver transplantation has had modest impact over time on HCC-specific mortality at the population level (liver transplantation was associated with a 0.5% reduction in the annual rate of increase in the IBM rate vs. nontransplant). Considering these findings, HCC screening and surveillance for early detection should be a priority, meanwhile, increased availability of liver transplantation for patients with HCC and other HCC curative-intent treatment modalities are also necessary to improve HCC survival. Moreover, HCC risk factors, viral hepatitis and nonalcoholic fatty liver disease prevention and treatment should also be incorporated in future HCC mortality research.See related article by Mahale et al., p. 513.