Current allocation policy is favorable for patients with hepatocellular carcinoma waiting for liver transplantation

Patients with hepatocellular carcinoma (HCC) are a growing population of the transplantation waiting list (WL) for orthotopic liver transplantation (OLT). There is no consensus to prioritize these patients while on the WL. To assess whether patients with HCC were more prioritized than non-HCC patien...

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Published in:Digestive and liver disease 2018-12, Vol.50 (12), p.1345-1350
Main Authors: Ferre-Aracil, Carlos, Lledó, José-Luis, Aguilera, Lara, Garcia-Paredes, Ana, Rodríguez-Santiago, Enrique, Graus, Javier, García-González, Miguel, Nuño, Javier, López-Buenadicha, Adolfo, López-Hervás, Pedro, Rodríguez-Gandía, Miguel, Gea, Francisco, Albillos, Agustín
Format: Article
Language:English
Subjects:
Allocation policy
Hepatocelullar carcinoma
Liver transplantation
Prioritization system
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Summary:Patients with hepatocellular carcinoma (HCC) are a growing population of the transplantation waiting list (WL) for orthotopic liver transplantation (OLT). There is no consensus to prioritize these patients while on the WL. To assess whether patients with HCC were more prioritized than non-HCC patients based on their WL survival as primary outcome. Restrospective cohort study including patients listed for elective OLT from January 2013 to January 2016. 165 patients with cirrhosis were listed for OLT: 64 in the HCC group (38.78%) and 101 in the non-HCC group (61.22%). Outcomes (HCC vs. non-HCC) were: OLT in 75.51% vs. 64.37%; death or dropout due to worsening in 20.41% vs. 27.59%, and delisting because of improvement in 4.08% vs. 8.05%. HCC patients had a significantly higher WL survival rate (HR = 0.45; 95% CI: 0.21–0.96); lower MELD score at transplantation (21 [20–24] vs. 24 [20–30]; p = 0.021); higher delta-MELD – the difference between MELD at transplantation and MELD at listing time – (3 [2–6] vs. 0 [0–5]; p = 0.024) and longer waiting time until OLT (143 [70–233] vs. 67 [21–164] days; p = 0.008). Despite having to wait longer, patients with HCC showed higher WL survival than non-HCC patients.
ISSN:1590-8658
1878-3562
DOI:10.1016/j.dld.2018.04.024