Introduction:Patients with in-criteria HCC listed for liver transplantation(OLT) receive exception MELD scores(EM) not adjusted for disease severity unless the calculated, true MELD score(TM) exceeds the EM.It is unknown whether TM is associated with transplant outcomes in HCC patients listed with EM scores.We hypothesize that elevated TM is associated with worse HCC patient survival independent of EM. Methods: Adult transplanted subjects with HCC were selected from the UNOS database if waitlisted from 2/27/2002-12/31/2009 and followed until10/31/2010. 6,805 subjects with HCC and OLT were included in the study.TM was calculated for HCC patients who had HCC EM score.Patients were grouped by TM score 0-20, 21-25, >25. Subject survival by EM score and TM category were analyzed using Kaplan Meier statistics and Cox modeling; differences were determined by log-rank tests.Results:Median EM score among transplanted HCC patients did not differ(23.8 vs 24.9) across TM score categories, indicating that EM score drives allocation in HCC cases.When stratifying patients by TM, those with TM >25 had significantly diminished patient survival than those with TM 0-20 and 21-25 (p<0.01).
HCC patients with TM 21-25 and TM >25 had hazards of 1.16 (p=0.25) and 1.94(p<0.01), respectively, compared to patients with TM 0-20. Three year patient survival for patients with TM 0-20, 21-25, and >25 were 77.4%, 74.4%, and 57.4%, respectively.Cause of death from recurrent HCV was more common in patients with TM<25 (6.9%) versus patients with TM>25(3.0%).However, cause of death due to recurrent HCC was similar in both groups, 23.1% and 21.2%.Conclusion:MELD exception scoring appears to be appropriate for compensated patients with HCC and TM ≤25.However, patients with HCC and TM >25 had worse survival than other HCC patients.Neither recurrent HCV nor recurrent HCC explained this finding.HCC with liver decompensation (TM>25) is a poor prognostic factor for survival after OLT and should be considered in patient selection for transplantation.
To cite this abstract in AMA style:Gupta M, Porrett P, Goldberg D, Abt P, Levine M. True MELD Score Is Associated with HCC Patient Outcomes after Liver Transplant [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/true-meld-score-is-associated-with-hcc-patient-outcomes-after-liver-transplant/. Accessed November 19, 2017.
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