Researchers from San Francisco, California, previously published an interim report on the intention-to-treat outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC).
In this study, the same team performed a follow-up analysis on an expanded cohort of 70 patients. They assessed whether the pattern and predictors of waiting list dropout are consistent with the current HCC-adjusted Model for End Stage Liver Disease (MELD) organ allocation scheme.
The team found that all but 1 one patient in the cohort had pretransplantation staging which met their expanded criteria. Criteria included a single lesion of 6.5 cm, or ≤ 3 lesions of which none were > 4.5 cm and total tumor diameter 8 cm.
Of the 70 patients, 38 patients received OLT.
|Probabilities of dropout at 6, 12, and 18 months were 7%, 38%, and 55%, respectively.|
The researchers found that the cumulative probabilities of dropout at 6, 12, and 18 months were 7%, 38%, and 55%, respectively.
However, they determined that dropout probabilities would have been 11%, 57%, and 69% if the United Network for Organ Sharing (UNOS) criteria for exclusion had been applied.
The team identified 3 tumor nodules and a single lesion > 3 cm at initial presentation, as predictors of dropout for both criteria.
Preoperative chemoembolization or ablation therapies were associated with a lower risk for dropout only when the UNOS criteria were applied.
In the subgroup with 2 or 3 lesions or a solitary tumor > 3 cm, the cumulative probabilities of dropout were 9-fold higher than those with a single lesion ≤ 3 cm.
Dr Francis Yao's team concluded, "The low dropout rate in the first 6 months and the differing dropout risks based on tumor characteristics support further refinements in the HCC-adjusted MELD organ allocation scheme".