Longer transplant waits for HCC patients may be beneficial

WASHINGTON — Patients with hepatocellular carcinoma have enhanced access to liver transplantation via MELD scoring system exceptions, but actually benefit less from liver transplant than other patients, according to study results presented at The Liver Meeting.

“Delaying liver transplant for [hepatocellular carcinoma] HCC may identify candidates with slowly progressing cancers who are most likely to have favorable post-transplant outcomes,” Barry Schlansky, MD, of the gastroenterology and hepatology department at Oregon Health and Science University, said. “This strategy may consequently improve access to liver transplant for non-HCC patients.”

Researchers analyzed information on three groups registered on the UNOS liver transplant wait list from March 2005 to March 2008. The first group was composed of patients who received MELD scoring system prioritization for HCC; the second was patients with HCC who did not receive MELD prioritization; and the third included patients without HCC with a goal of determining whether wait-list time after MELD prioritization for HCC is a predictor of survival after liver transplant.

Barry Schlansky

The study found median calculated MELD scores of 22 for group 1, 23 for group 2 and 24 for group 3 with survival rates of 92%, 89% and 91%, respectively, at 1 year after transplantation. Survival rates at 3 years after transplant were 81%, 77% and 84%, respectively. At 5 years after transplant, rates fell to 73%, 70% and 77%.

An independent association was observed between increased MELD status at transplant and longer survival time for group 1 (HR=0.84; 95% CI, 0.73-0.98), while increased MELD status was associated with short survival in group 2 (HR=1.17; 95% CI, 1.02-1.33) and group 3 (HR=1.20; 95% CI, 1.15-1.25).

Overall, liver transplant resulted in a 67% mortality reduction for group 2 patients, but only a 61% mortality reduction for the other groups.

“Increasing waiting time before liver transplant predicted longer post-transplant survival for HCC, and that’s a fact that was independent of clinical and demographic differences,” Schlansky said. “This suggests that increasing the lead time selects for a group of slowly progressing cancers that go on to have excellent post-transplant outcomes.”

Disclosure: Schlansky reports no relevant financial disclosures.

For more information:

Schlansky B. #2: Wait List Time Predicts Survival after Liver Transplantation for Hepatocellular Carcinoma: A Cohort Study in the UNOS Registry. Presented at: The Liver Meeting 2013; Nov. 1-5, Washington.