Center for Liver Diseases, University of Chicago Medicine, 5841 S. Maryland Ave. |MC 7120|, Chicago, IL, 60637, USA.
Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, USA.
Dig Dis Sci. 2019 Apr;64(4):985-992. doi: 10.1007/s10620-019-05549-y.
Identifying the optimal allocation policy with regard to hepatocellular carcinoma has been a persistent and evolving challenge. The current criteria for LT for HCC endorsed by the United Network of Organ Sharing (UNOS) are based on the Milan Criteria: a solitary tumor < 5 cm, or maximum of three tumors ≤ 3 cm each, without vascular invasion or evidence of extrahepatic spread. Contraindications to HCC exception points include: stage 1 HCC, ruptured HCC, extrahepatic HCC, and main portal or hepatic vein HCC invasion. Based upon projected waitlist dropout rates due to tumor growth, patients with HCC are assigned MELD standardized exception points. In addition to tumor size and number, AFP levels are an important predictor of recurrence of HCC following liver transplantation. Standardized exception points for HCC patients are not awarded to patients with AFP levels > 1000 ng/mL that do not decrease to < 500 ng/mL with treatment. Appeals for MELD exception points for patients with HCC vary widely between UNOS regions, with success of nonstandardized exception point appeals varying from 3.1 to 21% between regions. In an effort to make prioritization for HCC more consistent, a national liver review board (NLRB)is being convened that will focus on developing a national guidance for assessing common requests and addressing exception points, including for HCC.
确定肝细胞癌的最佳分配政策一直是一个持续且不断发展的挑战。目前，美国器官共享联合网络（UNOS）认可的用于 LT 的 HCC 标准基于米兰标准：单个肿瘤 <5cm，或最多三个肿瘤每个肿瘤均≤3cm，无血管侵犯或肝外扩散的证据。HCC 例外点的禁忌症包括：1 期 HCC、破裂 HCC、肝外 HCC 和主门静脉或肝静脉 HCC 侵犯。根据由于肿瘤生长导致的预计候补名单脱落率，HCC 患者被分配 MELD 标准化例外点。除了肿瘤大小和数量外，AFP 水平也是肝移植后 HCC 复发的重要预测因素。对于 AFP 水平>1000ng/mL 的 HCC 患者，不进行治疗而 AFP 水平降至<500ng/mL 以下的患者，不授予 HCC 患者标准化例外点。HCC 患者的 MELD 例外点申请在 UNOS 各区域之间差异很大，各区域之间非标准化例外点申请的成功率从 3.1%到 21%不等。为了使 HCC 的优先级排序更加一致，正在召集一个国家肝脏审查委员会（NLRB），该委员会将专注于制定评估常见请求和解决例外点的国家指导，包括 HCC。
