Faulkes Rosemary Elizabeth, Morris Sean, Bolimowska Oliwia, Rehman Zaira, Abbas Nadir, Dasari Bobby V M, Rajoriya Neil, Shah Tahir, Shetty Shishir
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Frontline Gastroenterol. 2025 Feb 10;16(5):e102773. doi: 10.1136/flgastro-2024-102773. eCollection 2025.
The incidence of hepatocellular carcinoma (HCC) continues to rise dramatically in the UK. Liver transplantation offers a potential cure and there is a large body of evidence demonstrating good outcomes. However, there is a paucity of data on the assessment, acceptance rates, and reasons for turning down liver transplantation in HCC.
We undertook an analysis of all patients with HCC referred for liver transplant assessment to a tertiary liver centre between January 2015 and January 2020. Patient and tumour demographics, assessment outcomes and overall survival were analysed. Multivariate analysis was performed on factors affecting listing decisions. To evaluate the impact of the COVID-19 pandemic, data collection was extended from March 2020 to March 2021.
Of 263 patients with HCC who completed liver transplant assessment, 168 (64%) were accepted for listing. The most common factors associated with a decision not to list a patient were medical comorbidities (n=50, 56.2% of those not listed) and rapid tumour progression (n=25, 26.3%). Of patients who were listed, 145 (86.4%) received a liver transplant. Five year survival from the time of transplant assessment was 68% with transplant and 12% without.The pandemic resulted in more patients progressing out of criteria after listing. Prepandemic median dropout per annum was 2% (0%-9%), compared with 25% during the pandemic study period.
This study provides outcomes on patients with HCC referred for transplant assessment, identifying factors for non-listing and confirming the negative impact of decreased transplant activity during the pandemic on waiting list dropouts for HCC patients.
在英国，肝细胞癌（HCC）的发病率持续急剧上升。肝移植提供了一种潜在的治愈方法，并且有大量证据表明疗效良好。然而，关于HCC患者肝移植评估、接受率以及拒绝肝移植的原因的数据却很匮乏。
我们对2015年1月至2020年1月期间转诊至一家三级肝脏中心进行肝移植评估的所有HCC患者进行了分析。分析了患者和肿瘤的人口统计学特征、评估结果和总生存率。对影响列入名单决策的因素进行了多变量分析。为了评估2019冠状病毒病大流行的影响，数据收集时间从2020年3月延长至2021年3月。
在263例完成肝移植评估的HCC患者中，168例（64%）被接受列入名单。与决定不将患者列入名单相关的最常见因素是合并症（n=50，未列入名单者的56.2%）和肿瘤快速进展（n=25，26.3%）。在列入名单的患者中，145例（86.4%）接受了肝移植。从移植评估时起的五年生存率，接受移植的患者为68%，未接受移植的患者为12%。大流行导致更多患者在列入名单后不符合标准。大流行前每年的中位退出率为2%（0%-9%），而在大流行研究期间为25%。
本研究提供了转诊进行移植评估的HCC患者的结果，确定了未列入名单的因素，并证实了大流行期间移植活动减少对HCC患者等待名单退出的负面影响。
