title: Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States.
abstract: 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.
authors.affiliation: Department of Transplantation and Hepatobiliary Surgery, Lahey Clinic Medical Center, 41 Mall Road, 4 West, Burlington, MA 01805, USA. elizabeth.a.pomfret@lahey.org
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pomfret
authors.forename: Kenneth
authors.initials: K
authors.lastname: Washburn
authors.forename: Christoph
authors.initials: C
authors.lastname: Wald
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nalesnik
authors.forename: David
authors.initials: D
authors.lastname: Douglas
authors.forename: Mark
authors.initials: M
authors.lastname: Russo
authors.forename: John
authors.initials: J
authors.lastname: Roberts
authors.forename: David J
authors.initials: DJ
authors.lastname: Reich
authors.forename: Myron E
authors.initials: ME
authors.lastname: Schwartz
authors.forename: Luis
authors.initials: L
authors.lastname: Mieles
authors.forename: Fred T
authors.initials: FT
authors.lastname: Lee
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Francis
authors.initials: F
authors.lastname: Yao
authors.forename: Ann
authors.initials: A
authors.lastname: Harper
authors.forename: Erick
authors.initials: E
authors.lastname: Edwards
authors.forename: Richard
authors.initials: R
authors.lastname: Freeman
authors.forename: John
authors.initials: J
authors.lastname: Lake
mesh_terms: 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