The Race to Liver Transplantation: A Comparison of Patients With and Without Hepatocellular Carcinoma from Listing to Post-Transplantation - 20/05/15

Doi : 10.1016/j.jamcollsurg.2014.12.050

Madhukar S. Patel, MD, MBA, ScM ^a, Rachel Kohn, MD ^c, Johannes R. Kratz, MD ^b, Jigesh A. Shah, DO ^a, James F. Markmann, MD, PhD, FACS ^a, Parsia A. Vagefi, MD, FACS ^a,^⁎
^a Department of Surgery, Massachusetts General Hospital, Boston, MA
^b Department of Surgery, University of California San Francisco, San Francisco, CA
^c Department of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA

^∗Correspondence address: Parsia A Vagefi, MD, FACS, Massachusetts General Hospital, 55 Fruit St, White 521c, Boston, MA 02114.

Abstract

Background

There are geographic and disease-specific inequities in liver allograft distribution. We examined differences between hepatocellular carcinoma (HCC) and non-HCC liver transplantation (LT) candidates from listing through LT in a region with prolonged wait times.

Study Design

We performed a single-center retrospective study, from 2005 to 2013, of adult, primary, nonstatus 1 candidates who were listed and subsequently underwent LT (n = 270), or were removed because of death or clinical deterioration (n = 277).

Results

Of the HCC candidates removed from the waitlist (n = 184), 5.5% died waiting, 25.5% deteriorated clinically, and 69% had LT. Of the non-HCC candidates (n = 363), 38.8% died waiting, 21.8% clinically deteriorated, and 39.4% had LT. Of the LT recipients, 127 (47%) had HCC. When compared with non-HCC transplant recipients, HCC recipients spent more time on the waitlist (435 ± 475 vs 301 ± 604 days, p = 0.045) and from listing until LT had higher total pre-transplant hospital admissions per patient (1.1 ± 1.2 vs 0.8 ± 1.8, p < 0.001). These admissions were more often planned (0.65 ± 0.88 vs 0.17 ± 0.52 planned admissions per patient, p < 0.001) and of shorter duration (2.7 ± 2.8 vs 5.2 ± 4.6 days, p < 0.001). The HCC and non-HCC recipients demonstrated similar overall post-transplant survival (5 year 80% vs. 83%, respectively; p = 0.84).

Conclusions

Despite a shorter wait to have LT, non-HCC candidates at our center have inferior waitlist outcomes. National reprioritization of liver allocation to improve access for non-HCC candidates may lead to increased wait time and resource use for the HCC population; however, a mortality benefit may exist for the non-HCC candidate lacking the benefit of time.

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Abbreviations and Acronyms : HCC, LT, MELD, UNOS

Plan

	Disclosure Information: Nothing to disclose.
	Support: This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C.
	Disclaimer: The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
	Drs Patel and Kohn contributed equally to this article.