HCC Liver Transplantation Wait List Dropout Rates Before and After the Mandated 6-Month Wait Time

Abstract

Background Studies have shown significant improvement in hepatocellular carcinoma (HCC) recurrence rates after liver transplantation since the united network of organ sharing (UNOS) implementation of a 6-month wait period prior to accrued exception model for end-stage liver disease (MELD) points enacted on October 8, 2015. However, few have examined the impact on HCC dropout rates for patients awaiting liver transplant. Our objective is to evaluate the outcomes of HCC dropout rates before and after the mandatory 6-month wait policy enacted. Methods We conducted a retrospective cohort study on adult patients added to the liver transplant wait list between January 1, 2012, and March 8, 2019 (n = 767). Information was obtained through electronic medical records and organ procurement and transplant network (OPTN) publicly available national data reports. Results In response to the 2015 UNOS-mandated 6-month wait time, dropout rates in the HCC patient population at our center increased from 12% pre-mandate to 20.8% post-mandate This increase was similarly reflected in the national dropout rate, which also increased from 26.3% pre-mandate to 29.0% post-mandate. Discussion From these changes, it is evident that the UNOS mandate achieved its goal of increasing equity of liver organ allocation, but HCC patients are nonetheless dropping off of the wait list at an increased rate and are therefore disadvantaged.

Approach to immunotherapy for HCC in the liver transplant population

“…[7] Multiple factors contribute to the high dropout rate, including the 6-month wait period before exception point accrual, variable wait times due to organ shortages, and invariable progression of disease or death. [7] These statistics highlight the frequent necessity to initiate HCC-targeted treatment before transplantation. This includes downstaging therapy to reduce tumor burden to meet qualifications for transplantation (Milan criteria) and bridging therapy to treat tumors while awaiting organ allocation.…”

HCC: Evolving Role of Systemic Therapies as a Bridging Treatment to Liver Transplantation

“…The biggest challenge for LT is organ shortage and long LT waiting lists leading to patients' dropout due to disease progression or liver decompensation [11]. In the USA, the national dropout rate for HCC patients from the transplant list reaches up to 29% as per the UNOS figures [12]. Thus, there is a need to implement therapies that control HCC until the availability of liver transplantation.…”

Hepatocellular Carcinoma: The Evolving Role of Systemic Therapies as a Bridging Treatment to Liver Transplantation

“…The biggest challenge for LT is organ shortage and long LT waiting lists, leading to patients’ dropout due to disease progression or liver decompensation [ 11 ]. In the USA, the national dropout rate from the transplant list for HCC patients reaches up to 29% as per the UNOS figures [ 12 ]. Thus, there is a need to implement therapies that control HCC until the availability of liver transplantation.…”