Favorable Survival with Non-curative Treatments for Patients with Early-Stage Hepatocellular Carcinoma After Liver Transplant Denial

Zori, Andreas G.; Villanueva, Faith; Hatamleh, Diana; Ismael, Media N.; Forde, Justin; Mota, Manoela; Johnson, Lindsey; Cabrera, Roniel

doi:10.1007/s10620-020-06201-w

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…In fact, patients with MELD <13 may actually have a negative survival benefit, considering the surgical risks associated with LT and post-LT immunosuppression and the greater availability and efficacy of nonsurgical options including radioembolization and immunotherapy [13,14]. Recently, a single-center study showed that patients with earlystage HCC and Child-Pugh class A cirrhosis had survival outcomes without LT comparable to the national average among recipients of LT (97%, 80%, 73% at 1, 3, and 5 years without LT, respectively), indicating that LT for low-risk HCC may not be worthwhile and may represent poor utilization of scarce organs [15].…”

Section: One Size Does Not Fit All: Limits To the Current Liver Alloc...mentioning

confidence: 99%

Optimizing liver transplant prioritization for hepatocellular carcinoma through risk stratification

Norman

Mehta

Kwong

2023

Current Opinion in Organ Transplantation

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Purpose of review In the United States, candidates with hepatocellular carcinoma (HCC) meeting standardized qualifying criteria receive similar priority on the liver transplant waiting list through Model for End-Stage Liver Disease exception points, without consideration of the dropout risk or relative expected benefit from liver transplantation. A more nuanced allocation scheme for HCC is needed to better represent the individual urgency for liver transplant and optimize organ utility. In this review, we discuss the development of HCC risk prediction models for practical use in liver allocation. Recent findings HCC is a heterogenous disease that requires improved risk stratification for patients who fall within current transplant eligibility criteria. Several models have been proposed, though none have been adopted in clinical practice or liver allocation to date, due to various limitations. Summary Improved HCC risk stratification for liver transplant candidates is needed to more accurately represent their urgency for transplant, with continued attention to the potential impact on post-liver transplant outcomes. Plans to implement a continuous distribution model for liver allocation in the United States may provide an opportunity to re-consider a more equitable allocation scheme for patients with HCC.

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Section: One Size Does Not Fit All: Limits To the Current Liver Alloc...mentioning

confidence: 99%

Optimizing liver transplant prioritization for hepatocellular carcinoma through risk stratification

Norman

Mehta

Kwong

2023

Current Opinion in Organ Transplantation

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“… 38 , 39 However, small retrospective cohort studies have suggested similar outcomes, based on national averages, for patients who undergo LT and patients with early-stage HCC and Child-Pugh A cirrhosis who were denied LT for non-tumour reasons. 40 …”

Section: Liver Transplantationmentioning

confidence: 99%

Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy?

Wu¹,

Lokken²,

Mehta³

2023

JHEP Reports

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Decreased Urgency Among Liver Transplantation Candidates With Hepatocellular Carcinoma in the United States

2021

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Early-stage hepatocellular carcinoma (HCC) has been an accepted indication for liver transplantation (LT) now for over 20 years. Allocation policy in the United States has been continually refined to maintain equity and optimize the utility of transplantation for HCC, yet all patients qualifying for HCC exception still receive the same number of points. This group is quite heterogeneous, with varying risk of waitlist dropout dependent on tumor characteristics including number and size of lesions and alpha-fetoprotein (AFP) level, as well as baseline liver function. In addition, changing demographics of liver disease, including the rising incidence of nonalcoholic steatohepatitis (NASH), effective antiviral therapy for hepatitis C virus, and earlier detection of HCC due to improved screening programs and awareness, may influence the overall survival benefit to LT.All adult candidates listed for primary LT in the Organ Procurement and Transplantation Network (OPTN) database between January 2005 and June 2021 who received at least 1 approved HCC exception were analyzed. United Network for Organ Sharing (UNOS) T2 was defined using conventional Milan criteria, with 1 lesion 2-5 cm or 2-3 lesions each ≤3 cm, and solitary HCC as a single lesion ≤3 cm at the first approved exception. A composite low-risk group was defined as Model for End-Stage Liver Disease (MELD) score <15, Child-Turcotte-Pugh (CTP) Class A, AFP ≤20 ng/mL, and a single tumor 2-3 cm at listing. (1) For listings after January 11, 2016, MELD-sodium was used instead of MELD, aligning with the change in allocation policy. Patients with T2 HCC were categorized using a recently proposed waitlist dropout risk score developed and validated using national OPTN data from 2010 to 2014. (2) Four eras were defined by the year

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Favorable Survival with Non-curative Treatments for Patients with Early-Stage Hepatocellular Carcinoma After Liver Transplant Denial

Cited by 3 publications

References 16 publications

Optimizing liver transplant prioritization for hepatocellular carcinoma through risk stratification

Optimizing liver transplant prioritization for hepatocellular carcinoma through risk stratification

Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy?

Decreased Urgency Among Liver Transplantation Candidates With Hepatocellular Carcinoma in the United States

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