Liver allocation for hepatocellular carcinoma: a European Center policy in the pre-MELD era.
BACKGROUND
Policies to decrease dropout during waiting time for liver transplantation (LT) are under debate.


METHODS
We evaluated the allocation system from 1996 to 2003, when recipients had priority related to Child-Pugh score and donors >60 years were mainly offered to recipients with hepatocellular carcinoma (HCC). The outcomes of 656 patients with chronic liver disease (142 HCC and 514 non-HCC) listed for LT were prospectively evaluated, considering recipient and donor features.


RESULTS
Transplantation and dropout rates were similar between HCC and non-HCC patients: 64.1% vs. 70.6% and 26% vs. 22.6%. Multivariate analysis showed the probability of being transplanted within 3 months was related to Child-Pugh score >10 and to HCC, whereas the probability of being removed from the list within 3 months was only related to Child-Pugh score >10. HCC patients had a lower median waiting time (97 vs. 197 days, P<0.001), a higher rate of donors > 60 years (50.5% vs. 33.5%, P<0.005) and with steatosis (31.6% vs. 14.3%, P<0.01), but a lower Child-Pugh score (9.1+/-2.1 vs. 9.6+/-1.7, P<0.05) than non-HCC patients. The 5-year patient survival was comparable since registration on the list and since LT: 56.9% and 77% in the HCC group vs. 61.4% and 79% in the non-HCC patients. Donors > 60 years affected outcome after LT in the non-HCC group, but not in the HCC patients.


CONCLUSIONS
By allocating donors >60 years mainly to HCC patients, we controlled dropout without affecting their survival and the outcome of non-HCC patients.
Department of Liver and Multiorgan Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy.
Matteo
M
Ravaioli
Gian Luca
GL
Grazi
Giorgio
G
Ercolani
Matteo
M
Cescon
Massimo
M
Del Gaudio
Matteo
M
Zanello
Giorgio
G
Ballardini
Giovanni
G
Varotti
Gaetano
G
Vetrone
Francesco
F
Tuci
Augusto
A
Lauro
Giovanni
G
Ramacciato
Antonio Daniele
AD
Pinna
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005060:Europe; D015276:Health Care Rationing; D006291:Health Policy; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D010352:Patient Dropouts; D011183:Postoperative Complications / Q000145:classification; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome