title: Can we direct organ allocation based on predicted outcome? Hepatocellular carcinoma outside of UCSF criteria or retransplant?
abstract: BACKGROUND
  In this study, we ask between patients with graft failure listed for retransplant and patients with hepatocellular carcinoma (HCC) outside of UCSF criteria, who has the greater survival benefit with transplantation?
  
  
  METHODS
  This is a retrospective analysis, of liver transplant (LT) patients, done between February 2002 and December 2009 at our center. Patients were included in the "extended HCC" group if their tumor was pathologically beyond UCSF criteria at LT and in the "redo" group if they underwent LT for graft failure occurring more than 3 months after the initial LT. Extended criteria donors (ECDs) were defined as donors above 70 years old, DCD, serology positive for HCV, and split grafts.
  
  
  RESULTS
  There were 25 redos and 37 extended HCC patients. Use of ECDs or high donor risk index organs was associated with poor outcome in both groups (P = 0.005). Overall, the extended HCC population had a much better survival than redos, both at 1 and 3 years.
  
  
  CONCLUSIONS
  These two very different but high risk patient populations have very different survival rates. At a time where regulatory agencies demand more and more with regards to transplant outcomes, we think the transplant community has to reflect on whether allocation justice and fair access to transplant are respected if we start allocating organs based on outcomes.
authors.affiliation: Transplant Center of Excellence, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA. rochonc@wcmc.com
authors.forename: Caroline
authors.initials: C
authors.lastname: Rochon
authors.forename: Patricia
authors.initials: P
authors.lastname: Sheiner
authors.forename: Basant
authors.initials: B
authors.lastname: Mahadevappa
authors.forename: Ganesh
authors.initials: G
authors.lastname: Gunasekaran
authors.forename: Joyti
authors.initials: J
authors.lastname: Sharma
authors.forename: David C
authors.initials: DC
authors.lastname: Wolf
authors.forename: Marcelo
authors.initials: M
authors.lastname: Facciuto
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D014481:United States / Q000453:epidemiology