It has been suggested that patients with hepatocellular carcinoma (HCC) undergoing living donor liver transplantation (LDLT) have worse recurrence-free survival, compared to deceased donor liver transplantation (CLT).
This led to the hypothesis that short waitlist time, or fast-tracking, may include more aggressive tumors - that would have been selected-out by traditional longer waitlist time.
Dr Francis Y. Yao and colleagues from the USA evaluated the impact of waitlist time on HCC recurrence.
|5-y survival was 86.6% for a waitlist time of 6 months.|
| American Journal of Transplantation |
The study cohort included 100 patients meeting T2 criteria by imaging before undergoing CLT (n = 90) or LDLT (n = 10).
The 5-year recurrence-free probability was 89.9% for the entire cohort, and 91.9%, 90.5% and 86.6%, respectively, for waitlist time of 3 months or less, 3-6 months and > 6 months (p = 0.81).
In the Cox proportional hazards model, waitlist time was also not a significant predictor of HCC recurrence.
Tumor under-staging was observed in 20.5% of patients with waitlist time 3 months or less and 23.0% for waitlist time > 3 months (p = 0.81).
Dr Yao concluded that, "Our results failed to show an association between waitlist time and outcome after CLT or LDLT for HCC, and provided evidence disputing a significant role of waitlist time in the selection against HCC with unfavorable tumor biology".