Listing for Liver Transplantation of Patients With Hepatocellular Carcinoma Using the Extended Toronto Criteria; an Intention-to-Treat Analysis

G. Sapisochin, N. Goldaracena, J. Laurence, A. Barbas, M. Dib, A. Ghanekar, M. Selzner, L. Lilly, I. McGilvray, M. Cattral, E. Renner, P. Greig, D. Grant.

Multi-Organ Transplant, Toronto General Hospital. University of Toronto, Toronto, ON, Canada.

Meeting: 2015 American Transplant Congress

Abstract number: D168

Keywords: Hepatocellular carcinoma, Liver transplantation

Session Information

Session Name: Poster Session D: Liver Transplantation for Hepatocellular Carcinoma

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

The role of liver transplantation for patients whose HCC exceeds Milan criteria remains controversial. At the University of Toronto, we have reported survivals of a large cohort of outside-Milan patients with moderate to well differentiated tumors with no macroscopic vascular invasion and no restrictions in size or tumor number that were similar to a contemporary cohort of patients within Milan criteria(Ann Surg 2011). The aim of this study was to analyze patients on an intention-to-treat basis(ITT)(i.e. from the time of listing) comparing those within and outside of Milan criteria.

This is a retrospective study. The Toronto criteria protocol was started in 2004. Patients were divided into Milan-In and Milan-Out depending on maximum tumor burden before transplant. Drop-outs were considered in case of tumor progression or death. Median follow-up from the time of listing: 50(0.6-130.3) months. Last follow-up: November 31, 2014.

Between January 2004 and December 2012, 476 patients were listed with known HCC. Of these, 291(61.1%) were Milan-In and 185(38.9%) Milan-Out. Dropout occurred in 87(18.3%) patients; and 389 patients were transplanted. There were significant differences in the rate of drop-out between those in the Milan-In group(14.4%) and the Milan-Out group(24.3%),p=0.006; most drop-outs were due to tumor progression. Waiting time was longer in those Milan-in 6.6(0.1-90) months vs. Milan-Out 4.9(0.1-44) months, p=0.005. No significant differences were observed between groups in sex, preoperative tumor treatment, type of graft (live vs deceased donor) or AFP at the time of transplant. The 1-,3- and 5-year actuarial survival from the time of listing was 88%,73%,64% (Milan-In) vs. 80%,65%,57% (Milan-Out),p=0.02. In the patients who were transplanted, the 1-,3- and 5-year actuarial survival from the time of transplant was 94%,83%,75% (Milan-In) vs. 95%,80%,73% (Milan-Out),p=0.64. The 1-,3- and 5-year cumulative risk of recurrence after transplant was 7%,13%,13% (Milan-In) vs. 11%,23%,24% (Milan-Out),p=0.02.

Listing patients for LT within the Extended Toronto Criteria achieves good results in terms of survival after transplant in an ITT basis. It is possible that the time on the waiting list "selects" the best candidates for liver transplant.

To cite this abstract in AMA style:

Sapisochin G, Goldaracena N, Laurence J, Barbas A, Dib M, Ghanekar A, Selzner M, Lilly L, McGilvray I, Cattral M, Renner E, Greig P, Grant D. Listing for Liver Transplantation of Patients With Hepatocellular Carcinoma Using the Extended Toronto Criteria; an Intention-to-Treat Analysis [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/listing-for-liver-transplantation-of-patients-with-hepatocellular-carcinoma-using-the-extended-toronto-criteria-an-intention-to-treat-analysis/. Accessed May 19, 2025.

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