Background: Candidates with exceptions for hepatocellular carcinoma (HCC) accounted for 29% of liver transplants during the first 6 months of 2012. OPTN policy requires submission of the post-transplant pathology form to confirm diagnosis of HCC for recipients with exceptions. From 2002 to 2012, these were submitted via facsimile to the OPTN contractor in a variety of formats, making analysis difficult. An on-line explant pathology form was implemented in April 2012. The OPTN Liver and Intestinal Organ Transplantation Committee, as part of its ongoing monitoring activity, is evaluating the efficacy and use of these forms for data analysis.
Methods: Validated OPTN Explant pathology forms submitted for liver transplants occurring between April 12, 2012 and the time of analysis were included.
Results: Of the 857 validated explant forms at time of analysis, 90.0% indicated pre-treatment for HCC. Ten percent showed no evidence of HCC on explant, but of these 87 patients, 77 (90%) had received pretransplant treatment for HCC. The level of tumor differentiation was reported as well, moderate, or poor in 28.1%, 50.5%, and 8.4% of cases with treatment resulting in complete tumor necrosis in 13.0% of cases. Most (84.3%) showed no vascular invasion, with 13.9% indicating microvascular and 1.8% with macrovascular invasion. Very few indicated lymph node involvement (2.1%) or extrahepatic spread (0.9%) and nearly 8% reported satellite lesions. Of the 515 recipients that were within Milan criteria (Stage T2) on imaging with evidence of HCC on explant, 124 (24%) exceeded criteria based on explant pathology.
Discussion: The vast majority of patients with a HCC MELD exception demonstrated tumor within the explant, and nearly 3/4 of those with tumor information were within Milan criteria. The great majority of patients now receive pretransplant locoregional therapy. New online pathology forms greatly facilitated ease of explant data analysis. Once sufficient data have accumulated, it will be important to monitor these data for post-transplant outcomes based on pre-transplant treatment, stage and differentiation given the high percentage of livers allocated to these candidates.
To cite this abstract in AMA style:Harper A, Edwards E, Heimbach J, Hirose R, Freeman R, Olthoff K. Early Look at the OPTN Explant Pathology Form Data, An [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/early-look-at-the-optn-explant-pathology-form-data-an/. Accessed October 19, 2020.
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