title: Chemoembolization decreases drop-off risk of hepatocellular carcinoma patients on the liver transplant list.
abstract: BACKGROUND
  The drop-off risk for patients awaiting liver transplantation for hepatocellular carcinoma (HCC) is 22%. Transplant liver availability is expected to worsen, resulting in longer waiting times and increased drop-off rates. Our aim was to determine whether chemoembolization can decrease this risk.
  
  
  METHODS
  Eighty-seven consecutive HCC patients listed for liver transplant (Milan criteria) underwent statistical comparability adjustments using the propensity score (Wilcoxon, Fisher's, and chi-square tests). Forty-three nonchemoembolization patients and 22 chemoembolization patients were comparable for Child-Pugh and Model for End-Stage Liver Disease scores, tumor size and number, alpha fetoprotein (AFP) levels, and cause of cirrhosis. We calculated the risk of dropping off the transplant list by assigning a transplant time to those who dropped off (equal probability with patients who were on the list longer than the patient in question). The significance level was obtained by calculating the simulation distribution of the difference compared with the permutations of chemoembolization versus nonchemoembolization assignment of the patients. Kaplan-Meier estimators (log-rank test) were used to determine survival rates.
  
  
  RESULTS
  Median follow-up was 187 ± 110 weeks (range 38 to 435, date of diagnosis). The chemoembolization group had an 80% drop-off risk decrease (15% nonchemoembolization versus 3% chemoembolization, p = 0.04). Although survival was better for the chemoembolization group, it did not reach statistical significance. Two-year survival for the nonchemoembolization and chemoembolization group was 57.3% ± 7.1% and 76.0% ± 7.9%, respectively (p = 0.078).
  
  
  CONCLUSIONS
  Chemoembolization appears to result in a significant decrease in the risk of dropping off liver transplant list for patients with HCC and results in a tendency toward longer survival.
authors.affiliation: Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Constantine
authors.initials: C
authors.lastname: Frangakis
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.forename: Yong
authors.initials: Y
authors.lastname: Chen
authors.forename: Ayman
authors.initials: A
authors.lastname: Koteish
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hong
authors.forename: Eleni
authors.initials: E
authors.lastname: Liapi
authors.forename: Christos S
authors.initials: CS
authors.lastname: Georgiades
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005780:Gelatin / Q000008:administration & dosage; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000180:Acrylic Resins; D000970:Antineoplastic Agents; C496735:trisacryl gelatin microspheres; D004998:Ethiodized Oil; D005780:Gelatin