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Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the Eurotransplant allocation system.

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Adler, Michael De Pauw, Filip Vereerstraeten, Pierre Fancello, Agnese Lerut, Jan [UCL] Starkel, Peter [UCL] Nevens, Frederik

Although hepatocellular carcinoma (HCC) has become a recognized indication for liver transplantation, the rules governing priority and access to the waiting list are not well defined. Patient- and tumor-related variables were evaluated in 226 patients listed primarily for HCC in Belgium, a region where the allocation system is patient-driven, priority being given to sicker patients, based on the Child-Turcotte-Pugh (CTP) score. Intention-to-treat and posttransplantation survival rates at 4 years were 56.5 and 66%, respectively, and overall HCC recurrence rate was 10%. The most significant predictors of failure to receive a transplant in due time were baseline CTP score equal to or above 9 (relative risk [RR] 4.1; confidence interval [CI]: 1.7-9.9) and alpha fetoprotein above 100 ng/mL (RR 3.0; CI: 1.2-7.1). Independent predictors of posttransplantation mortality were age equal to or above 50 years (RR 2.5; CI: 1.0-3.7) and United Network for Organ Sharing pathological tumor nodule metastasis above the Milan criteria (RR 2.1; CI: 1.0-5.9). Predictors of recurrence (10%) were alpha fetoprotein above 100 ng/mL (RR 3.2; CI:1.1-10) and vascular involvement of the tumor on the explant (RR 3.6; CI: 1.1-11.3). Assessing the value of the pretransplantation staging by imaging compared to explant pathology revealed 34% accuracy, absence of carcinoma in 8.3%, overstaging in 36.2%, and understaging in 10.4%. Allocation rules for HCC should consider not only tumor characteristics but also the degree of liver impairment. Patients older than 50 years with a stage above the Milan criteria at transplantation have a poorer prognosis after transplantation.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2008
Language Anglais
Journal information "Liver Transplantation" - Vol. 14, no.4, p. 526-33 (2008)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. ((United States) Hoboken)
issn 1527-6465
e-issn 1527-6473
Publication status Publié
Affiliations UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie
UCL - (SLuc) Service d'hépato-gastro-entérologie
UCL - (SLuc) Service de chirurgie et transplantation abdominale
MESH Subject Adolescent ; Liver Transplantation ; Male ; Middle Aged ; Patient Selection ; Resource Allocation ; Waiting Lists ; Adult ; Aged ; Carcinoma, Hepatocellular ; Europe ; Female ; Health Care Rationing ; Humans ; Liver Neoplasms
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Bibliographic reference Adler, Michael ; De Pauw, Filip ; Vereerstraeten, Pierre ; Fancello, Agnese ; Lerut, Jan ; et. al. Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the Eurotransplant allocation system.. In: Liver Transplantation, Vol. 14, no.4, p. 526-33 (2008)
Permanent URL http://hdl.handle.net/2078.1/124561