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HCC most common indication for LT, waitlist placement in US

In 2015, hepatocellular carcinoma was the most common indication for liver transplantation in the U.S., yet the likelihood of receiving a transplantation decreased the most among waitlist registrants with this cancer, according to recent study data.

“LT registrants and recipients with HCC have continued to increase over the past 12 years, making HCC the leading indication among both LT registrants and recipients in 2015,” researchers wrote. “Despite the institution of the Share 35 policy and the consequent decreased probability of receiving LT in HCC registrants, the number of HCC recipients continues to increase due to the more rapid increase in the number of registrants.”

To evaluate trends in the etiologies for LT, investigators performed a retrospective study of all adults registered for LT in the U.S. from 2004 through 2015, identified using the United Network for Organ Sharing/Organ Procurement and Transplantation Network. They compared 2004-2010 data with 2011-2014 data to assess whether the introduction of direct-acting antivirals in 2011 affected pre- and post-LT outcomes for patients with HCV infection.

The investigators considered HCC as the primary diagnosis in the event of multiple diagnoses.

Overall, 18.5% of 109,018 patients were registered for LT due to HCC, and in 2015, 23.9% of registrants and 27.2% of LT recipients had HCC.

Between 2004 and 2014, the ratio of registrants with HCC vs. registrants without HCC increased by 5.6 times among patients with HCV infection, by 1.9 times among patients with HBV infection, by 2.7 times among patients with alcohol abuse and by 10.2 times among patients with nonalcoholic steatohepatitis.

The investigators observed a reduced likelihood that HCC registrants would receive LT between 2011 and 2014 (HR = 0.62; 95% CI, 0.59-0.64; P < .0001), and observed a reduced likelihood of dropout caused by deterioration or death due to HCV-induced liver disease (HR = 0.9; 95% CI, 0.86-0.95; P = .0003), HBV-induced liver disease (HR = 0.71; 95% CI, 0.57-0.89; P = .002), or alcohol-induced liver disease (HR = 0.9; 95% CI, 0.84-0.97; P = .01). On the other hand, they observed an increased likelihood of delisting because of clinical improvements in patients infected with HCV (HR = 3.42; 95% CI, 2.66-4.39; P < .0001) or HBV (HR = 2.25; 95% CI, 1.29-3.93; P = .004), or those with alcohol abuse (HR = 2.21; 95% CI, 1.75-2.8; P < .0001).

Finally, they observed reduced odds of graft loss or death during the same period, especially among LT recipients with HCV infection (HR = 0.76; 95% CI, 0.71-0.82; P < .0001).

“The number of HCV registrants without HCC declined rapidly in recent years possibly due to wide availability and effectiveness of DAA in prevention of hepatic decompensation,” the researchers wrote. “On the other hand, LT registrants with NASH and alcohol etiology continued to increase and alcohol is the most common listing diagnosis among non-HCC registrants in 2015.”

The reduced number of graft failures among HCV-infected recipients is also encouraging, and likely reflects the increased use of anti-HCV therapies post-LT, they added. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.