title: A new liver transplant priority for patients with hepatocellular carcinoma.
abstract: 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.
authors.affiliation: Department of Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vetrone
authors.forename: Takuya
authors.initials: T
authors.lastname: Kimura
authors.forename: Matteo
authors.initials: M
authors.lastname: Zanello
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Giovanni
authors.initials: G
authors.lastname: Varotti
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Francesco
authors.initials: F
authors.lastname: Tuci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Giuliano
authors.initials: G
authors.lastname: La Barba
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Augusto
authors.initials: A
authors.lastname: Lauro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: 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