Wait and transplant for stage 2 hepatocellular carcinoma with deceased-donor liver grafts

Transplantation. 2013 Dec 15;96(11):995-9. doi: 10.1097/TP.0b013e3182a339a7.

Abstract

Background: As a new scheme at our center, a Model for End-stage Liver Disease score of 18 points is assigned to candidates of deceased-donor liver transplantation (DDLT) who have hepatocellular carcinoma (HCC) remaining at stage 2 six months after their disease has been confirmed stage 2 HCC. Two points are added every 3 months if their disease remains at stage 2 or below. This study evaluated patient and tumor characteristics as well as surgical and short-term outcomes of DDLT in these patients.

Methods: Comparison of survival was made among three groups of patients who underwent liver transplantation (LT) in the same period. Group 1 consisted of 22 HCC patients who received DDLT under the new scheme. Group 2 consisted of 18 HCC patients who underwent living-donor LT. Group 3 consisted of 52 patients who underwent DDLT because of liver failure, among whom 6 had HCC but were not included in the new scheme.

Results: Group 1 had a median follow-up period of 17.9 months, and the 1-, 3-, and 5-year overall survival rates were 100%, 100%, and 80%, respectively. Group 2 had the corresponding rates at 100%, 100%, and 100% with a median follow-up of 19.6 months. Group 3 had the corresponding rates at 96.1%, 96.1%, and 96.1% with a median follow-up of 19.4 months.

Conclusions: The policy of a 6-month wait has benefited the HCC patients who practically had no chance of undergoing living-donor LT. Their survival outcomes will be excellent as long as they can stand the test of time.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / pathology
  • Carcinoma, Hepatocellular / surgery*
  • Chi-Square Distribution
  • Decision Support Techniques
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / mortality
  • Liver Neoplasms / pathology
  • Liver Neoplasms / surgery*
  • Liver Transplantation* / adverse effects
  • Liver Transplantation* / mortality
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Patient Selection
  • Risk Factors
  • Survival Rate
  • Time Factors
  • Tissue and Organ Procurement
  • Treatment Outcome
  • Waiting Lists* / mortality
  • Young Adult