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Response to Therapy as a Criterion for Awarding Priority to Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

How to prioritize patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) remains controversial. This study was designed to assess the effectiveness of a policy for prioritizing HCC patients according to their response to pre-LT therapy.

Methods

The study period was from 2000 to 2008. Dropout criteria included macroscopic vascular invasion, metastases, and poorly differentiated grade at pre-LT biopsy. A specific treatment algorithm was adopted to treat HCC before LT, and the effect of treatment was evaluated 3 months after listing or after the diagnosis of HCC for patients diagnosed while already on the waiting list. Patients were divided into two groups: group 1, patients with disease that completely or partially responded to therapy; and group 2, patients with stable, progressive, or untreatable disease. Group 2 patients were prioritized for LT unless full restaging and repeat biopsy identified dropout criteria.

Results

At the 3-month visit, 62 HCC patients (42%) were assigned to group 2 and 85 (58%) to group 1. Eleven of 12 dropouts due to tumor progression came from group 2 (P < 0.01). Response to therapy was the sole predictor of dropout probability, independent of tumor stage (competing risk analysis). The 42 patients in group 2 who were transplanted had much the same 3-year post-LT survival rate as the 57 transplanted patients in group 1 (with survival rates of 82% and 83%, respectively; P > 0.05), but a slightly higher risk of post-LT HCC recurrence (13% and 2%, respectively; P = 0.04).

Conclusions

Response to therapy is a potentially effective tool for prioritizing HCC patients for LT.

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Authors and Affiliations

  1. Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IRCCS, Padova, Italy

    Alessandro Vitale MD, PhD

  2. Dipartimento di Chirurgia Generale e Trapianti d’Organo, Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera-Università di Padova, Padova, Italy

    Francesco D’Amico MD, PhD, Alberto Brolese MD, Giacomo Zanus MD, PhD, Daniele Neri MD, Amedeo Carraro MD, Francesco Enrico D’Amico MD & Umberto Cillo MD

  3. Dipartimento di Medicina Ambientale e Sanità Pubblica, Unità di Biostatistica ed Epidemiologia, Università di Padova, Padova, Italy

    Anna Chiara Frigo MD & Francesco Grigoletto MD

  4. Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Divisione di Gastroenterologia, Università di Padova, Padova, Italy

    Patrizia Burra MD & Francesco Russo MD

  5. Dipartimento di Medicina Clinica e Sperimentale Clinica Medica V, Università di Padova, Padova, Italy

    Paolo Angeli MD

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  1. Alessandro Vitale MD, PhD
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  2. Francesco D’Amico MD, PhD
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Correspondence to Alessandro Vitale MD, PhD.

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Vitale, A., D’Amico, F., Frigo, A.C. et al. Response to Therapy as a Criterion for Awarding Priority to Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation. Ann Surg Oncol 17, 2290–2302 (2010). https://doi.org/10.1245/s10434-010-0993-4

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  • DOI: https://doi.org/10.1245/s10434-010-0993-4

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