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HCC exception policy for liver transplant reduces survival benefit for patients with HCC

Researchers from the Veterans Affairs Puget Sound Health Care System, Seattle, Washington, found that the hepatocellular carcinoma MELD exception policy reduces liver transplantation-related survival benefit in patients with hepatocellular carcinoma, according to published findings.

“Because patients with HCC are transplanted at significantly lower mean MELD score than patients without HCC, due to the HCC MELD exception policy, we hypothesized that patients with HCC might derive a substantially lower survival benefit,” the researchers wrote.

Kristin Berry, PhD, and George N. Ioannou, MD, MS, modeled the post-transplantation survival of adults who underwent a liver transplant with HCC (n = 9,135) and without HCC (n = 25,890) between the date the MELD allocation system was introduced from 2002 through 2013 and modeled the waitlist survival of patients listed for transplantation with HCC (n = 15,605) or without HCC (n = 85,229).

“We used these survival models to calculate monthly transition probabilities and 5-year life expectancies,” the researchers wrote. “Survival benefit was calculated as the difference between post-transplantation and waitlist life expectancy.”

Overall, the 5-year survival benefit increased with actual MELD score for both groups of patients. The survival benefit of patients with HCC was similar to patients without HCC who had the same actual MELD score, regardless of tumor burden or serum level of alpha-fetoprotein. However, patients with HCC received transplants at a lower mean MELD score (13.3 ± 6.2) compared with patients without HCC (21.8 ± 8), indicating a much lower mean 5-year survival benefit between the two groups (0.12 years per patient with HCC vs. 1.47 years per patient without HCC).

No trends in transplant-related survival benefit of patients with or without HCC when comparing time periods 2002−2004, 2005−2007 and 2008−2010, at 5-year survival benefit or 3-year survival, were observed, according to the research.

“Our study is the first, to our knowledge, to demonstrate that patients transplanted with HCC MELD exceptions derive significantly reduced survival benefit from transplantation compared with patients transplanted without HCC,” the researchers wrote. “Combined with the aforementioned studies, our findings strongly argue against the current HCC MELD exception policy, and suggest that any system that artificially raises the MELD score of patients with HCC is likely to lead to a reduction in transplantation-related survival benefit.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.