medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2017, Number 3

<< Back Next >>

Ann Hepatol 2017; 16 (3)

Liver Transplantation for Hepatocellular Carcinoma: Impact of Wait Time at a Single Center

Palmer WC, Lee D, Burns J, Croome K, Rosser B, Patel T, Keaveny AP, Pungpapong S, Satyanarayana R, Yataco M, Nakhleh R, Musto K, Canabal AM, Turnage AK, Hodge DO, Nguyen JH, Harnois DM

Language: English
References: 38
Page: 402-411
PDF size: 169.48 Kb.


ABSTRACT

Introduction and aim. Liver transplantation (LT) provides durable survival for hepatocellular carcinoma (HCC). However, there is continuing debate concerning the impact of wait time and acceptable tumor burden on outcomes after LT. We sought to review outcomes of LT for HCC at a single, large U.S. center, examining the influence of wait time on post-LT outcomes. Material and methods. We reviewed LT for HCC at Mayo Clinic in Florida from 1/1/2003 until 6/30/2014. Follow up was updated through 8/1/ 2015. Results. From 2003-2014, 978 patients were referred for management of HCC. 376 patients were transplanted for presumed HCC within Milan criteria, and the results of these 376 cases were analyzed. The median diagnosis to LT time was 183 days (8 - 4,337), and median transplant list wait time was 62 days (0 - 1815). There was no statistical difference in recurrence-free or overall survival for those with wait time of less than or greater than 180 days from diagnosis of HCC to LT. The most important predictor of long term survival after LT was HCC recurrence (HR: 18.61, p ‹ 0.001). Recurrences of HCC as well as survival were predicted by factors related to tumor biology, including histopathological grade, vascular invasion, and pre-LT serum alpha-fetoprotein levels. Disease recurrence occurred in 13%. The overall 5-year patient survival was 65.8%, while the probability of 5-year recurrence- free survival was 62.2%. Conclusions. In this large, single-center experience with long-term data, factors of tumor biology, but not a longer wait time, were associated with recurrence-free and overall survival.


REFERENCES

  1. Samoylova ML, Dodge JL, Yao FY, Roberts JP. Time to transplantation as a predictor of hepatocellular carcinoma recurrence after liver transplantation. Liver Transplant 2014; 20: 937-44.

  2. Schlansky B, Chen Y, Scott DL, Austin D, Naugler WE. Waiting time predicts survival after liver transplantation for hepatocellular carcinoma: a cohort study using the United Network for Organ Sharing registry. Liver Transplant 2014; 20: 1045-56.

  3. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124: 91-6.

  4. Barbara L, Benzi G, Gaiani S, Fusconi F, Zironi G, Siringo S, Rigamonti A, et al. Natural history of small untreated hepatocellular carcinoma in cirrhosis: a multivariate analysis of prognostic factors of tumor growth rate and patient survival. Hepatology 1992; 16: 132-7.

  5. Sharma P, Balan V, Hernandez JL, Harper AM, Edwards EB, Rodriguez-Luna H, Byrne T, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact. Liver Transplant 2004; 10: 36-41.

  6. Sharma P, Harper AM, Hernandez JL, Heffron T, Mulligan DC, Wiesner RH, Balan V. Reduced priority MELD score for hepatocellular carcinoma does not adversely impact candidate survival awaiting liver transplantation. Am J Transplant 2006; 6: 1957-62.

  7. Washburn K, Edwards E, Harper A, Freeman R. Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system. Am J Transplant 2010; 10: 1643-8.

  8. Goldberg D, French B, Abt P, Feng S, Cameron AM. Increasing disparity in waitlist mortality rates with increased model for end-stage liver disease scores for candidates with hepatocellular carcinoma versus candidates without hepatocellular carcinoma. Liver Transplantat 2012; 18: 434-43.

  9. Northup PG, Intagliata NM, Shah NL, Pelletier SJ, Berg CL, Argo CK. Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End- Stage Liver Disease (MELD) inflation. Hepatology 2015; 61: 285-91.

  10. Halazun KJ, Patzer RE, Rana AA, Verna EC, Griesemer AD, Parsons RF, Samstein B, et al. Standing the test of time: outcomes of a decade of prioritizing patients with hepatocellular carcinoma, results of the UNOS natural geographic experiment. Hepatology 2014; 60: 1957-62.

  11. Hyder O, Dodson RM, Nathan H, Herman JM, Cosgrove D, Kamel I, Geschwind JF, et al. Referral patterns and treatment choices for patients with hepatocellular carcinoma: a United States population-based study. J Am College Surg 2013; 217: 896-906.

  12. Heimbach JK, Hirose R, Stock PG, Schladt DP, Xiong H, Liu J, Olthoff KM, et al. Delayed hepatocellular carcinoma model for end-stage liver disease exception score improves disparity in access to liver transplant in the United States. Hepatology 2015; 61: 1643-50.

  13. US Department of Health and Human Services Transplant Program Awards. 2012. Available from: http:// www.hrsa.gov/about/news/2012tables/121004transplant awards.html.

  14. Lee DD, Croome KP, Perry DK, Burns JM, Nguyen JH, Keaveny AP, Taner CB. Liver Transplantation at Mayo Clinic Florida. Clin Transplants 2014; 83-90.

  15. Harnois DM, Steers J, Andrews JC, Rubin JC, Pitot HC, Burgart L, Wiesner RH, et al. Preoperative hepatic artery chemoembolization followed by orthotopic liver transplantation for hepatocellular carcinoma. Liv Transplant Surg 1999; 5: 192-9.

  16. Nguyen JH, Dickson RC, Harnois DM. A decade of liver transplantation at Mayo Clinic in Florida. Clin Transplants 2008; 127-35.

  17. Available from: http://www.cap.org/apps/docs/committees/ cancer/cancer_protocols/2009/Hepatocellular_09 protocol.pdf.

  18. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, Ascher NL, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33: 1394-403.

  19. Wald C, Russo MW, Heimbach JK, Hussain HK, Pomfret EA, Bruix J. New OPTN/UNOS policy for liver transplant allocation: standardization of liver imaging, diagnosis, classification, and reporting of hepatocellular carcinoma. Radiology 2013; 266: 376-82.

  20. Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, Greenstein SM, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 2006; 6: 783-90.

  21. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-43.

  22. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-2.

  23. Naugler WE, Alsina AE, Frenette CT, Rossaro L, Sellers MT. Building the Multidisciplinary Team for Management of Patients With Hepatocellular Carcinoma. Clin Gastroenterol Hepatol 2014.

  24. Northup PG, Intagliata NM, Shah NL, Pelletier SJ, Berg CL, Argo CK. Excess mortality on the liver transplant waiting list: Unintended policy consequences and MELD Inflation. Hepatology 2014.

  25. Duffy JP, Vardanian A, Benjamin E, Watson M, Farmer DG, Ghobrial RM, Lipshutz G, et al. Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg 2007; 246: 502-9; discussion 509-511.

  26. Huang J, Zeng Y. Current clinical uses of the biomarkers for hepatocellular carcinoma. Drug discoveries & therapeutics 2014; 8: 98-9.

  27. Ramanathan R, Sharma A, Lee DD, Behnke M, Bornstein K, Stravitz RT, Sydnor M, et al. Multimodality therapy and liver transplantation for hepatocellular carcinoma: a 14-year prospective analysis of outcomes. Transplantation 2014; 98: 100-6.

  28. Sharma P, Welch K, Hussain H, Pelletier SJ, Fontana RJ, Marrero J, Merion RM. Incidence and risk factors of hepatocellular carcinoma recurrence after liver transplantation in the MELD era. Digestive diseases and sciences 2012; 57: 806- 12.

  29. Kim JM, Kwon CH, Joh JW, Park JB, Lee JH, Kim GS, Kim SJ, et al. Expanded criteria for liver transplantation in patients with hepatocellular carcinoma. Transplantation proceedings 2014; 46: 726-9.

  30. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. New Engl J Med 1996; 334: 693-9.

  31. Vauthey JN, Ribero D, Abdalla EK, Jonas S, Bharat A, Schumacher G, Lerut J, et al. Outcomes of liver transplantation in 490 patients with hepatocellular carcinoma: validation of a uniform staging after surgical treatment. J Am College Surg 2007; 204: 1016-27; discussion 1027-8.

  32. Yao FY, Kerlan RK, Jr., Hirose R, Davern TJ, 3rd, Bass NM, Feng S, Peters M, et al. Excellent outcome following downstaging of hepatocellular carcinoma prior to liver transplantation: an intention-to-treat analysis. Hepatology 2008; 48: 819-27.

  33. Yao FY, Xiao L, Bass NM, Kerlan R, Ascher NL, Roberts JP. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant 2007; 7: 2587-96.

  34. Hemming AW, Cattral MS, Reed AI, Van Der Werf WJ, Greig PD, Howard RJ. Liver transplantation for hepatocellular carcinoma. Ann Surg 2001; 233: 652-9.

  35. Jonas S, Bechstein WO, Steinmuller T, Herrmann M, Radke C, Berg T, Settmacher U, et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 2001; 33: 1080-6.

  36. Xu Y, Fan J, Zhou J, Qiu SJ, Wu ZQ, Yu Y, Hang XW, et al. Influence of tumor characteristics on the outcome of liver transplantation among patients with hepatocellular carcinoma. Zhonghua yi xue za zhi 2007; 87: 2101-4.

  37. Bittermann T, Hoteit MA, Abt PL, Forde KA, Goldberg D. Waiting time and explant pathology in transplant recipients with hepatocellular carcinoma: a novel study using national data. Am J Transplant 2014; 14: 1657-63.

  38. Schlansky B, Chen Y, Scott DL, Austin D, Naugler WE. Waiting time predicts survival after liver transplantation for hepatocellular carcinoma: A cohort study in the UNOS registry. Liver Transplant 2014.




2020     |     www.medigraphic.com