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Title: Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the eurotransplant allocation system
Authors: Adler, Michael ×
De Pauw, Fillip
Vereerstraeten, Pierre
Fancello, Agnese
Lerut, Jan
Starkel, Peter
Van Vlierberghe, Hans
Troisi, Roberto
Donckier, Vincent
Detry, Olivier
Delwaide, Jean
Michielsen, Peter
Chapelle, Thierry
Pirenne, Jacques
Nevens, Frederik #
Issue Date: Apr-2008
Publisher: John wiley & sons inc
Series Title: Liver transplantation vol:14 issue:4 pages:526-533
Abstract: 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 [Cl]: 1.7-9.9) and a fetoprotein above 100 ng/mL (RR 3.0; Cl: 1.2-7.1). Independent predictors of posttransplantation mortality were age equal to or above 50 years (RR 2.5; Cl: 1.0-3.7) and United Network for Organ Sharing pathological tumor nodule metastasis above the Milan criteria (RR 2.1; Cl: 1.0-5.9). Predictors of recurrence (10%) were a fetoprotein above 100 ng/mL (RR 3.2; Cl:1.1-10) and vascular involvement of the tumor on the explant (RR 3.6; Cl: 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.
URI: 
ISSN: 1527-6465
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Abdominal Transplantation
Hepatology
Laboratory of Nephrology
× corresponding author
# (joint) last author

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