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Longer wait to liver transplantation associated with reduced HCC recurrence

Risk for hepatocellular carcinoma recurrence after liver transplantation was lower among patients who waited more than 120 days from exception to transplantation compared with patients who did not in a recent study.

John P. Roberts, MD; Mariya L. Samoylova; and colleagues from the department of surgery, University of California, San Francisco, analyzed data from 5,002 adult liver transplantation candidates from the United Network for Organ Sharing. All were granted initial exceptions because of hepatocellular carcinoma (HCC) diagnoses between January 2006 and September 2010. Patients waiting no more than 120 days for a transplant were compared with those waiting longer.

“We used the regional differences in waiting time for liver transplantation to answer the question whether patients with liver cancer should wait a period of time prior to transplantation,” Roberts told Healio.com/Hepatology.

Mariya Samoylova

The cumulative incidence rate of HCC recurrence after transplantation was 3.3% (95% CI, 2.8-3.8) within 1 year and 5.6% (95% CI, 5-6.3) within 2 years. Recurrence rates for HCC within 1 year of transplant were lower among patients who waited more than 120 days (2.2%) vs. those who waited 120 days or less (3.9%; P=.002). The rate, however, did not remain lower at 2 years after transplantation (5% vs. 5.9%; P=.09).

When factoring in tumor quantity and size, ablative therapy and other factors, HCC recurrence risk was reduced by 40% in patients waiting longer than 120 days for transplantation (P=.005).

“This waiting period is to make sure that the tumor has not spread outside of the liver so that it would not be cured by liver transplantation,” Roberts said. “We found that a waiting period of 120 days appears to decrease the risk of post-transplant recurrence.”

“We think that the waiting period may help doctors to decide who will benefit the most from a new liver,” Samoylova told Healio.com/Hepatology.

Disclosure: The researchers report no relevant financial disclosures.