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The Liver Transplant Timeline: A Comparison of Patients With and Without Hepatocellular Carcinoma From Listing to Post-Transplant Care
*Madhukar S. Patel, *Rachel Kohn, *Johannes R. Kratz, James F. Markmann, *Parsia A Vagefi
Massachusetts General Hospital/Harvard Medical School, Boston, MA, MA
Objective: Assess healthcare utilization and transplant outcomes for patients with hepatocellular carcinoma (HCC) and without (non-HCC).
Design: Single center retrospective study from 1/1/05 to 1/1/13.
Setting: Tertiary care center within UNOS Region 1.
Patients: Adult, primary, non-status one recipients who were listed and subsequently achieved liver transplantation (LT) at our center during the study period. (n=270)
Interventions: N/A
Main Outcome Measures: Demographics, LT characteristics, pre-transplant admissions, and patient disease-free survival comparisons between the HCC and non-HCC groups.
Results: Of the LT recipients, 127 of 270 (47%) had HCC. When compared to non-HCC recipients; HCC recipients were significantly older (59±6 vs. 52±10 years, p<0.001), more likely to be male (85% vs. 73%, p=0.014), and had significantly lower MELD scores at listing (11±4 vs. 23±9, p<0.001) and at transplant (28±5 vs. 32±7, p<0.001). Significantly more HCC recipients had MELD exception points (99.2% vs 6.3%, p<0.001). From listing until LT, HCC patients had a significantly higher number of total hospital admissions per patient (1.1±1.3 vs 0.8±1.8, p<0.001), however, these were more often planned and significantly shorter in duration (2.7±2.8 vs. 5.2±4.6 days, p=0.002). HCC LT recipients spent significantly more time on the waitlist (435±475 vs. 295±586, p=0.03). HCC and non-HCC recipients demonstrated similar overall survival (1 year 92% vs. 89%, p=0.3; and 5 year 80% vs. 83%; p=0.8).
Conclusions: We demonstrate that HCC recipients can wait for LT without jeopardizing survival. In regions with more accelerated times to LT, re-prioritization of HCC liver allocation may lead to increase resource utilization through prolonged waitlist times, but in so doing may allow for improved access to those candidates whose survival may be compromised by a longer waiting period.
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