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Impact of Locoregional Treatment and Waiting Times in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma, The

J. Lohlun, P. Mahawithitwong, D. Radosevich, S. Chinnakotla, T. Pruett

Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, MN

Meeting: 2013 American Transplant Congress

Abstract number: A711

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AIM: To study the impact of locoregional treatment and waiting time before liver transplantation for hepatocellular carcinoma (HCC)

METHODS: A retrospective review of 104 HCC patients undergoing liver transplantation from 2005 and 2011. Time-to-event analysis was used to summarize oncological outcomes in terms of HCC recurrence and HCC-specific mortality. Multivariate Cox proportional hazard regression models were used to evaluate the effects of locoregional treatment, waiting time, transplant eras, Milan criteria and other potential risk factors on each outcome. Kaplan-Meier survival analyses of outcome at 1, 2, 3, 4 and 5 years were evaluated.

RESULTS: Neither waiting time nor locoregional treatment was independently associated with outcomes. Pathology results showed 24 out of 104 patients (23.1%) out of Milan criteria at the time of transplant. Pretransplant alphafetoprotein (AFP) level greater than 10 ng/dL statistically increased the risk of HCC recurrence (Relative Risk [RR] 1.01, p 0.033) and HCC-specific mortality (RR 1.02, p 0.01). HCC-specific mortality was statistically lower in the early era (RR 0.14, p 0.046). Patients with tumors outside Milan criteria at transplant had statistically similar outcomes for HCC recurrence (RR 1.41, p 0.651) and HCC-specific mortality (RR 1.19, p 0.85).

CONCLUSION: The current score system used to allocate livers for transplantation in HCC patients has no deleterious effect on cancer outcomes despite increased waiting time and locoregional treatment. Although complete longer term outcomes are not available, 5 year results indicate that progression beyond Milan criteria at transplant was unrelated to oncological outcomes with increased waiting time.

Multivariate Cox Proportional Hazards Regression Models for HCC Recurrence and HCC-Specific Mortality.
  HCC Recurrence (RR) HCC Recurrence (p value) HCC Specific Mortality (RR) HCC Specific Mortality (p value)
Waiting Time        
< 62 days 1.00 * 1.00 *
62 – 154 days 0.88 0.860 0.43 0.447
155 – 237 days 0.20 0.218 0.21 0.239
>237 days 0.58 0.565 0.55 0.537
Locoregional treatment 0.796 0.753 1.73 0.634
Transplant Era        
2008 to 2011 1.00 * 1.00 *
2005 to 2007 0.31 0.098 0.14 0.046
Milan Criteria ( within vs outside ) 0.71 0.651 0.84 0.850
Etiology ( non-HCV vs HCV ) * * 0.22 0.055
Deceased vs Living Donor 0.20 0.014 * *
MELD (> 16) * * 0.84 0.072
Pretransplant AFP(>10ng/dl) 1.01 0.033 1.02 0.010
* Insufficient events to estimate
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To cite this abstract in AMA style:

Lohlun J, Mahawithitwong P, Radosevich D, Chinnakotla S, Pruett T. Impact of Locoregional Treatment and Waiting Times in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-locoregional-treatment-and-waiting-times-in-patients-undergoing-liver-transplantation-for-hepatocellular-carcinoma-the/. Accessed January 21, 2021.

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