Objectives: The success of LRT has served as a tool to select a subgroup of patients exceeding transplant criteria but potentially achieving meaningful outcome with downstaging. We report our long-term ITT outcomes of patients with HCC undergoing transplantation exceeding Milan criteria (MC).

Methods: Listed HCC patients from two large institutions were analyzed during the period 2001-2014. The downstaging subgroups included outside Milan and UCSF criteria and were compared to patients within MC.

Results: Of the 1668 patients, 24% were outside Milan and 11% outside UCSF criteria at time of listing. The 2-year cumulative probability for dropout was 30% in the downstaging vs. 25% in the T2 group (p=0.05). Overall waitlist drop-out rates were comparable in both groups (22% vs. 20% within MC). 1,3,5 year post-transplant survival were 88%,73% and 59% in the downstaging vs. 88%,77% and 69% in the T2 group (p=0.16). The 1,3,5-year ITT survival was 82%,63% and 49% in the downstaging (outside MC) vs. 83%, 67% and 59% in the T2 group (p=0.053). The 1,3,5-year ITT survival outside UCSF was 82%,62% and 51% respectively. The only independent predictor of WL dropout in the down-staging group was a maximum AFP >200 prior to transplant (p<0.0001,HR 2.95,CI 2.09-4.16) . The cumulative waitlist mortality rate using competing risk regression model was similar in both groups (p=0.36,HR 1.11,CI 0.88-1.39).

Conclusion: Successful down-staging to within MC was associated with excellent outcomes. ITT survival, waitlist drop out, and post transplant survival were comparable to patients who initially started within criteria. Centers should be encouraged to move forward with listing patients with HCC who are well beyond criteria without fear of poor outcomes.

CITATION INFORMATION: Tabrizian P., Holzner M., Emond J., Florman S., Brown R., Schwartz M., Halazun K. Intention to Treat Outcomes of Patients with Hepatocellular Carcinoma Downstaged to within Milan Am J Transplant. 2017;17 (suppl 3).

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