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Longer transplant wait times yielded higher survival rates for patients with HCC
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Liver transplant recipients in the long waiting time region who underwent transplantation due to hepatocellular carcinoma had a greater survival rate after transplant compared with patients on the short waiting time region list, according to study data.
“Patients with HCC have different waiting times and resultant pre-transplant treatment algorithms depending on where they are listed,” the researchers wrote. “We therefore sought to design a study to examine the impact of differential waiting times on the outcomes of large cohorts of patients with HCC who meet the T2 exception criteria.”
A total of 6,166 patients with HCC and T2 tumors and down-staged T3 tumors in regions 3, 5, 9 and 10 were included in the study. Patients in regions 3 and 10 were deemed the short waiting time region (SWTR) and compared with patients in regions 5 and 9, the long waiting time region (LWTR). The median waiting time for the SWTR was 1.6 months, and 7.6 months for patients in the LWTR. Researchers analyzed data for patient survival using three different patient cohorts: intent-to-treat, post-transplant and overall survival for patients who underwent transplant.
Overall, 94% of patients in the SWTR underwent transplantation compared with 78% in the LWTR. Of all the patients, 6% died while on the wait list (n=368). Wait-list mortality was higher among the LWTR patients compared with the SWTR patients (8.4% vs. 1.6%; P<.0001), accounting for 86% of all wait-list deaths. However, the intent-to-treat patient 5-year survival rate was higher in the LWTR compared with the SWTR (70% vs. 66%; P<.0001), as well as the 5-year survival rate for the post-transplant cohort (69% vs. 65%; P<.0001) and 5-year overall patient survival rate after transplant (75% vs. 67%; P<.0001).
Univariate analysis showed SWTR, older age and hepatitis C virus infection to be some of the factors associated with poor OS among the patients.
“This study provides population-based evidence that expediting patients with HCC to transplant at too fast a rate adversely affects outcomes, with a more than 8% difference in post-transplant survival existing between short and long access time regions,” the researchers concluded. “Because overall waiting time is an independent predictor of poor outcome, we would suggest that further iterations in allocation policy toward HCC be considered.”
Disclosure: One researcher reports receiving grants from Bristol-Myers Squibb.