Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States.
A national conference was held to better characterize the long-term outcomes of liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) and to assess whether it is justified to continue the policy of assigning increased priority for candidates with early-stage HCC on the transplant waiting list in the United States. The objectives of the conference were to address specific HCC issues as they relate to liver allocation, develop a standardized pathology report form for the assessment of the explanted liver, develop more specific imaging criteria for HCC designed to qualify LT candidates for automatic Model for End-Stage Liver Disease (MELD) exception points without the need for biopsy, and develop a standardized pretransplant imaging report form for the assessment of patients with liver lesions. At the completion of the meeting, there was agreement that the allocation policy should result in similar risks of removal from the waiting list and similar transplant rates for HCC and non-HCC candidates. In addition, the allocation policy should select HCC candidates so that there are similar posttransplant outcomes for HCC and non-HCC recipients. There was a general consensus for the development of a calculated continuous HCC priority score for ranking HCC candidates on the list that would incorporate the calculated MELD score, alpha-fetoprotein, tumor size, and rate of tumor growth. Only candidates with at least stage T2 tumors would receive additional HCC priority points.
Pomfret
Elizabeth A
EA
Department of Transplantation and Hepatobiliary Surgery, Lahey Clinic Medical Center, 41 Mall Road, 4 West, Burlington, MA 01805, USA. elizabeth.a.pomfret@lahey.org
Washburn
Kenneth
K
Wald
Christoph
C
Nalesnik
Michael A
MA
Douglas
David
D
Russo
Mark
M
Roberts
John
J
Reich
David J
DJ
Schwartz
Myron E
ME
Mieles
Luis
L
Lee
Fred T
FT
Florman
Sander
S
Yao
Francis
F
Harper
Ann
A
Edwards
Erick
E
Freeman
Richard
R
Lake
John
J
D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000473:pathology / Q000601:surgery*; D017408:Guidelines as Topic; D006287:Health Planning Guidelines; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018579:Patient Selection; D040841:Resource Allocation / Q000639:trends*; D012307:Risk Factors; D009927:Tissue and Organ Procurement / Q000639:trends*; D014481:United States; D014850:Waiting Lists