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Transplantation. 2017 May;101(5):1099-1105. doi: 10.1097/TP.0000000000001660.

Characterizing the Risk of False-Positive Hepatocellular Carcinoma in Recipients Transplanted With T2 MELD Exceptions.

Author information

1
1 Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA. 2 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA. 3 Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC.

Abstract

BACKGROUND:

Patients with hepatocellular carcinoma (HCC) can receive Model for End-Stage Liver Disease (MELD) exception points to increase waitlist priority for liver transplantation. This process does not require a biopsy and is based on radiologic criteria. However, imaging modalities are imperfect, and some will ultimately have no HCC on explant.

METHODS:

This was a retrospective cohort study using national explant pathology data from 2012 to 2015. False-positive HCC was defined as answering "no" to the question: "was evidence of HCC (viable or nonviable) found in the explant?" in patients with T2 MELD exceptions.

RESULTS:

Four thousand one hundred seventeen patients received T2 MELD exceptions, of which 245 (6%) had false-positive HCC. Maximal tumor diameter of 3 to 5 cm and serum α fetoprotein (AFP) greater than 100 ng/mL at transplant yielded a 50% lower risk of false-positive HCC (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.27-0.73 and OR, 0.57; 95% CI, 0.37-0.88, respectively). Recipients with immune-mediated liver disease were twice as likely to have no HCC on explant (OR, 2.12; 95% CI, 1.18-3.83) and had a predicted probability of false positive HCC greater than 10% regardless of largest tumor size or AFP. Significant among-center variability in the rate of false-positive HCC was seen.

CONCLUSIONS:

The risk of false-positive HCC is markedly higher in certain groups, such that biopsy may be warranted before T2 MELD exception point approval. Transplant centers with high false-positive HCC rates may benefit from greater oversight.

PMID:
28121908
DOI:
10.1097/TP.0000000000001660
[Indexed for MEDLINE]

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