Expanding Selection Criteria in Deceased Donor Liver Transplantation for Hepatocellular Carcinoma: Long-term Follow-up of a National Registry and 2 Transplant Centers.
作者信息
Wehrle Chase J, Kusakabe Jiro, Akabane Miho, Maspero Marianna, Zervos Bobby, Modaresi Esfeh Jamak, Whitsett Linganna Maureen, Imaoka Yuki, Khalil Mazhar, Pita Alejandro, Kim Jaekeun, Diago-Uso Teresa, Fujiki Masato, Eghtesad Bijan, Quintini Cristiano, Kwon Choon David, Pinna Antonio, Aucejo Federico, Miller Charles, Mazzaferro Vincenzo, Schlegel Andrea, Sasaki Kazunari, Hashimoto Koji
机构信息
Department of Surgery, Transplantation Center, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
Department of Surgery, Stanford University Hospital, Palo Alto, CA.
出版信息
Transplantation. 2024 Dec 1;108(12):2386-2395. doi: 10.1097/TP.0000000000005097. Epub 2024 Jun 4.
BACKGROUND
This study compares selection criteria for liver transplant (LT) for hepatocellular carcinoma (HCC) for inclusivity and predictive ability to identify the most permissive criteria that maintain patient outcomes.
METHODS
The Scientific Registry of Transplant Recipients (SRTR) database was queried for deceased donor LT's for HCC (2003-2020) with 3-y follow-up; these data were compared with a 2-center experience. Milan, University of California, San Francisco (UCSF), 5-5-500, Up-to-seven (U7), HALT-HCC, and Metroticket 2.0 scores were calculated.
RESULTS
Nationally, 26 409 patients were included, and 547 at the 2 institutions. Median SRTR-follow-up was 6.8 y (interquartile range 3.9-10.1). Three criteria allowed the expansion of candidacy versus Milan: UCSF (7.7%, n = 1898), Metroticket 2.0 (4.2%, n = 1037), and U7 (3.5%, n = 828). The absolute difference in 3-y overall survival (OS) between scores was 1.5%. HALT-HCC (area under the curve [AUC] = 0.559, 0.551-0.567) best predicted 3-y OS although AUC was notably similar between criteria (0.506 < AUC < 0.527, Mila n = 0.513, UCSF = 0.506, 5-5-500 = 0.522, U7 = 0.511, HALT-HCC = 0.559, and Metroticket 2.0 = 0.520), as was Harrall's c-statistic (0.507 < c-statistic < 0.532). All scores predicted survival to P < 0.001 on competing risk analysis. Median follow-up in our enterprise was 9.8 y (interquartile range 7.1-13.3). U7 (13.0%, n = 58), UCSF (11.1%, n = 50), HALT-HCC (6.4%, n = 29), and Metroticket 2.0 (6.3%, n = 28) allowed candidate expansion. HALT-HCC (AUC = 0.768, 0.713-0.823) and Metroticket 2.0 (AUC = 0.739, 0.677-0.801) were the most predictive of recurrence. All scores predicted recurrence and survival to P < 0.001 using competing risk analysis.
CONCLUSIONS
Less restrictive criteria such as Metroticket 2.0, UCSF, or U7 allow broader application of transplants for HCC without sacrificing outcomes. Thus, the criteria for Model for End-stage Liver Disease-exception points for HCC should be expanded to allow more patients to receive life-saving transplantation.
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