Evaluating the Validity of Model for End-stage Liver Disease Exception Points for Hepatocellular Carcinoma Patients with Multiple Nodules <2 cm

Overview

Journal Clin Transplant

Specialty General Surgery

Date 2014 Nov 5

PMID 25366656

Citations 1

Authors

Mariya L Samoylova

Jennifer L Dodge

Neil Mehta

Francis Y Yao

John P Roberts

Affiliations

Soon will be listed here.

Abstract

Liver transplant allocation policy does not give model for end-stage liver disease (MELD) exception points for patients with a single hepatocellular carcinoma (HCC) <2 cm in size, but does give points to patients with multiple small nodules. Because standard-of-care imaging for HCC struggles to differentiate HCC from other nodules, it is possible that a subset of patients receiving liver transplant for multiple nodules <2 cm in size does not have HCC. We evaluate risk of post-transplant HCC recurrence and wait-list dropout for patients with multiple small nodules using competing risks regression based on the Fine and Gray model. We identified 5002 adult HCC patients in the OPTN/UNOS dataset diagnosed and transplanted between January 2006 and September 2010. Compared to patients with >1 tumor <2 cm, risk of developing recurrence was significantly higher in patients with one or more tumors with only one tumor ≥2 cm (SHR 1.63, p = 0.009), as well as in patients with 2-3 tumors ≥2 cm (SHR 1.84, p = 0.02). Dropout risk was not significantly different among size categories. HCC recurrence risk was significantly lower in patients with multiple nodules <2 cm in size than in those with larger tumors, supporting the possibility that some patients received unnecessary transplants. The priority given to these patients must be re-examined.

Citing Articles

Misdiagnosis of hepatocellular carcinoma in patients receiving no local-regional therapy prior to liver transplant: An analysis of the Organ Procurement and Transplantation Network explant pathology form.

Mehta N, Dodge J, Roberts J, Hirose R, Yao F Clin Transplant. 2017; 31(11).

PMID: 28881064 PMC: 5937711. DOI: 10.1111/ctr.13107.

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