title: Response to therapy as a criterion for awarding priority to patients with hepatocellular carcinoma awaiting liver transplantation.
abstract: BACKGROUND
  How to prioritize patients with hepatocellular carcinoma (HCC) for liver transplantation (LT) remains controversial. This study was designed to assess the effectiveness of a policy for prioritizing HCC patients according to their response to pre-LT therapy.
  
  
  METHODS
  The study period was from 2000 to 2008. Dropout criteria included macroscopic vascular invasion, metastases, and poorly differentiated grade at pre-LT biopsy. A specific treatment algorithm was adopted to treat HCC before LT, and the effect of treatment was evaluated 3 months after listing or after the diagnosis of HCC for patients diagnosed while already on the waiting list. Patients were divided into two groups: group 1, patients with disease that completely or partially responded to therapy; and group 2, patients with stable, progressive, or untreatable disease. Group 2 patients were prioritized for LT unless full restaging and repeat biopsy identified dropout criteria.
  
  
  RESULTS
  At the 3-month visit, 62 HCC patients (42%) were assigned to group 2 and 85 (58%) to group 1. Eleven of 12 dropouts due to tumor progression came from group 2 (P < 0.01). Response to therapy was the sole predictor of dropout probability, independent of tumor stage (competing risk analysis). The 42 patients in group 2 who were transplanted had much the same 3-year post-LT survival rate as the 57 transplanted patients in group 1 (with survival rates of 82% and 83%, respectively; P > 0.05), but a slightly higher risk of post-LT HCC recurrence (13% and 2%, respectively; P = 0.04).
  
  
  CONCLUSIONS
  Response to therapy is a potentially effective tool for prioritizing HCC patients for LT.
authors.affiliation: Unità di Chirurgia Oncologica, Istituto Oncologico Veneto, IRCCS, Padova, Italy. alessandro.vitale@unipd.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigoletto
authors.forename: Alberto
authors.initials: A
authors.lastname: Brolese
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Daniele
authors.initials: D
authors.lastname: Neri
authors.forename: Amedeo
authors.initials: A
authors.lastname: Carraro
authors.forename: Francesco Enrico
authors.initials: FE
authors.lastname: D'Amico
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Francesco
authors.initials: F
authors.lastname: Russo
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006292:Health Priorities; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists