Liver transplantation for hepatocellular carcinoma: The... : Liver Transplantation (original) (raw)

Original Articles

Sharma, Pratima1; Balan, Vijayan*,1,†; Hernandez, Jose L.3; Harper, Ann M.4; Edwards, Erick B.4; Rodriguez-Luna, Hector1; Byrne, Thomas1; Vargas, Hugo E.1; Mulligan, David2; Rakela, Jorge1; Wiesner, Russell H.5

1Transplantation Medicine, Mayo Clinic, Scottsdale, AZ

2Transplantation Surgery, Mayo Clinic, Scottsdale, AZ

3Section of Biostatistics, Mayo Clinic, Scottsdale, AZ

4United Network of Organ Sharing, Richmond, VA

5Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN

E-mail:[email protected]

*Address reprint requests to: Division of Transplantation Medicine, Mayo Clinic Hospital, 5777 E. Mayo Blvd., 5th Fl., Phoenix, AZ 85054

†Telephone: 480-342-0516; FAX: 480-324-2324

Abstract

The new allocation policy of the United Network of Organ Sharing (UNOS) based on the model for end-stage liver disease (MELD) gives candidates with stage T1 or stage T2 hepatocellular carcinoma (HCC) a priority MELD score beyond their degree of hepatic decompensation. The aim of this study was to determine the impact of the new allocation policy on HCC candidates before and after the institution of MELD. The UNOS database was reviewed for all HCC candidates listed between July 1999 and July 2002. The candidates were grouped by two time periods, based on the date of implementation of new allocation policy of February 27, 2002. Pre-MELD candidates were listed for deceased donor liver transplantation (DDLT) before February 27,2002, and post-MELD candidates were listed after February 27, 2002. Candidates were compared by incidence of DDLT, time to DDLT, and dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting and after DDLT. Incidence rates calculated for pre-MELD and post-MELD periods were expressed in person years. During the study, 2,074 HCC candidates were listed for DDLT in the UNOS database. The DDLT incidence rate was 0.439 transplant/person years pre-MELD and 1.454 transplant/person years post-MELD (P < 0.001). The time to DDLT was 2.28 years pre-MELD and 0.69 years post-MELD (P < 0.001). The 5-month dropout rate was 16.5% pre-MELD and 8.5% post-MELD (P < 0.001). The 5-month waiting-list survival was 90.3% pre-MELD and 95.7% post-MELD (P < 0.001). The 5-month survival after DDLT was similar for both time periods. The new allocation policy has led to an increased incidence rate of DDLT in HCC candidates. Furthermore, the 5-month dropout rate has decreased significantly. In addition, 5-month survival while waiting has increased in the post-MELD period. Thus, the new MELD-based allocation policy has benefited HCC candidates. (Liver Transpl 2004;10:36-41.)