Risk Factors for Dropout From the Liver Transplant Waiting List of Hepatocellular Carcinoma Patients Under Locoregional Treatment

Lee, H.A.; Cho, E.Y.; Kim, T.H.; Lee, Y.; Suh, Sang Jun; Jung, Young Kul; Kim, J.H.; An, Hyonggin; Seo, Yeon Seok; Kim, D.-S.; Yim, Hyung Joon; Yeon, Jong Eun; Byun, Kwan Soo; Um, Soon Ho

doi:10.1016/j.transproceed.2018.08.021

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Orthotopic liver transplant is advocated in stage A patients falling within the Milan Criteria or University of California, San Francisco criteria. Currently, dropout rates range from 8.9-9.4% at six months and up to 19.6% at 12 months [52,53]. Furthermore, in the United States, the United Network for Organ Sharing (UNOS) has introduced a six-month delay in the assignment of exception points for patients with HCC.…”

Section: Bridge To Transplantmentioning

confidence: 99%

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Kishore

Bajwa

Madoff

2020

Cancers

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Hepatocellular carcinoma (HCC) represents a significant contributor to cancer-related morbidity and mortality with increasing incidence in both developing and developed countries. Embolotherapy as a locoregional therapeutic strategy consists of trans-arterial or “bland” embolization (TAE), trans-arterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Trans-catheter arterial therapies can be applied along all stages of HCC, either as an alternative or neoadjuvant to surgical resection/transplantation in very early and early stage HCC or as a palliative option for local disease control in unresectable and advanced stage HCC. In advanced stage HCC, SIRT did not demonstrate superiority in comparison to systemic treatment options in several recent large prospective trials, though for carefully selected patients, may confer improved tolerability with similar disease control rates. The latest embolotherapeutic techniques and literature as they pertain to the management of HCC, as well as future directions, are reviewed in this article.

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Section: Bridge To Transplantmentioning

confidence: 99%

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Kishore

Bajwa

Madoff

2020

Cancers

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“…Current studies have identified risk factors for dropout, but these studies lack uniformity in access to donor organs. Known risk factors for patient dropout while on the waitlist include a high AFP at time of listing, rapid rise in AFP, lack of response to locoregional therapy and synthetic liver dysfunction [ 13 , 54 , 58 , 59 ]. The exact value of static listing AFP level associated with dropout varies widely per study, with ranges from 20 to 400 ng/mL quoted [ 13 , 60 ].…”

Section: Hcc Afp and Liver Transplantmentioning

confidence: 99%

Hepatocellular Carcinoma, Alpha Fetoprotein, and Liver Allocation for Transplantation: Past, Present and Future

et al. 2022

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Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation and has been the treatment of choice due to the oncologic benefit for patients with advanced chronic liver disease (AdvCLD) and small tumors for the last 25 years. For HCC patients undergoing liver transplantation, alpha fetoprotein (AFP) has increasingly been applied as an independent predictor for overall survival, disease free recurrence, and waitlist drop out. In addition to static AFP, newer studies evaluating the AFP dynamic response to downstaging therapy show enhanced prognostication compared to static AFP alone. While AFP has been utilized to select HCC patients for transplant, despite years of allocation policy changes, the US allocation system continues to take a uniform approach to HCC patients, without discriminating between those with favorable or unfavorable tumor biology. We aim to review the history of liver allocation for HCC in the US, the utility of AFP in liver transplantation, the implications of weaving AFP as a biomarker into policy. Based on this review, we encourage the US transplant community to revisit its HCC organ allocation model, to incorporate more precise oncologic principles for patient selection, and to adopt AFP dynamics to better stratify waitlist dropout risk.

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“… 2 Furthermore, as liver transplantation is the only definitive treatment for patients at high risk of mortality, prognosis prediction is important for decision making and allocating liver grafts. 3 , 4 However, cirrhosis is an extremely heterogeneous disease comprising various factors; 5 - 7 hence, predicting prognosis of patients with cirrhosis is challenging.…”

Section: Introductionmentioning

confidence: 99%

Direct Bilirubin Is More Valuable than Total Bilirubin for Predicting Prognosis in Patients with Liver Cirrhosis

et al. 2021

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Background/Aims Most prognostic prediction models for patients with liver cirrhosis include serum total bilirubin (TB) level as a component. This study investigated prognostic performance of serum direct bilirubin (DB) and developed new DB level-based prediction models for cirrhosis. Methods A total of 983 hospitalized patients with liver cirrhosis were included. DB-Model for End-Stage Liver Disease (MELD) score was calculated using MELD score formula, with serum DB level replacing TB level. Results Mean age of study population was 56.1 years. Alcoholic liver disease was the most frequent underlying condition (471 patients, 47.9%). Within 6 months, 144 patients (14.6%) died or received liver transplantation due to severe liver dysfunction. The area under the receiver operating characteristic curve (AUROC) for prediction of 6-month mortality with DB level was significantly higher than that with TB level (p<0.001). The AUROC of DB-MELD score for prediction of 6-month mortality was significantly higher than that of MELD score (p<0.001). Patients were randomly divided into training (n=492) and validation (n=491) cohorts. A new prognostic prediction model, “Direct Bilirubin, INR, and Creatinine” (DiBIC) score, was developed based on the most significant predictors of 6-month mortality. In training set, AUROC of DiBIC score for prediction of 6-month mortality was 0.892, which was significantly higher than that of the MELD score (0.875, p=0.017), but not different from that of DB-MELD score (0.886, p=0.272). Similar results were observed in validation set. Conclusions New prognostic models, DB-MELD and DiBIC scores, have good prognostic performance in liver cirrhosis patients, outperforming other currently available models.

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Risk Factors for Dropout From the Liver Transplant Waiting List of Hepatocellular Carcinoma Patients Under Locoregional Treatment

Cited by 4 publications

References 26 publications

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Embolotherapeutic Strategies for Hepatocellular Carcinoma: 2020 Update

Hepatocellular Carcinoma, Alpha Fetoprotein, and Liver Allocation for Transplantation: Past, Present and Future

Direct Bilirubin Is More Valuable than Total Bilirubin for Predicting Prognosis in Patients with Liver Cirrhosis

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