A new liver transplant priority for patients with hepatocellular carcinoma.
OBJECTIVE
Patients with hepatocellular carcinoma on the waiting list for liver transplantation are excluded due to causes related to liver failure and tumor progression. We analyze the various factors to suggest a new liver transplant priority.


METHODS
We evaluated the outcome on the list of 309 patients with hepatocellular carcinoma and causes of drop-out from the list were divided as death, "too sick" and tumor progression. The impact of model for end stage liver disease score, tumor stage and waiting time on the causes of drop-outs was evaluated.


RESULTS
During the study period, 197 patients had a liver transplantation, 50 were still on the list and the remaining 62 were removed from the list (28 deaths, 30 tumor progressions, and 4 "too sick"). The receiver operating characteristic curves analysis showed that the model for end stage liver disease score predicted the rate of deaths on the list at 1-year (p<0.001). The waiting time and the tumor stage predicted the rate of drop-outs for tumor progression at 1-year on the list (p<0.05).


CONCLUSIONS
Patients with hepatocellular carcinoma on the waiting list should have priority based on their model for end stage liver disease score, waiting time with tumor and tumor stage.
Ravaioli
Matteo
M
Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Grazi
Gian Luca
GL
Vetrone
Gaetano
G
Kimura
Takuya
T
Zanello
Matteo
M
Ercolani
Giorgio
G
Cescon
Matteo
M
Varotti
Giovanni
G
Del Gaudio
Massimo
M
Tuci
Francesco
F
Cucchetti
Alessandro
A
La Barba
Giuliano
G
Vivarelli
Marco
M
Lauro
Augusto
A
Ramacciato
Giovanni
G
Pinna
Antonio Daniele
AD
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000145:classification; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012372:ROC Curve; D012720:Severity of Illness Index; D014850:Waiting Lists