Wait and transplant for stage 2 hepatocellular carcinoma with deceased-donor liver grafts.
BACKGROUND
As a new scheme at our center, a Model for End-stage Liver Disease score of 18 points is assigned to candidates of deceased-donor liver transplantation (DDLT) who have hepatocellular carcinoma (HCC) remaining at stage 2 six months after their disease has been confirmed stage 2 HCC. Two points are added every 3 months if their disease remains at stage 2 or below. This study evaluated patient and tumor characteristics as well as surgical and short-term outcomes of DDLT in these patients.


METHODS
Comparison of survival was made among three groups of patients who underwent liver transplantation (LT) in the same period. Group 1 consisted of 22 HCC patients who received DDLT under the new scheme. Group 2 consisted of 18 HCC patients who underwent living-donor LT. Group 3 consisted of 52 patients who underwent DDLT because of liver failure, among whom 6 had HCC but were not included in the new scheme.


RESULTS
Group 1 had a median follow-up period of 17.9 months, and the 1-, 3-, and 5-year overall survival rates were 100%, 100%, and 80%, respectively. Group 2 had the corresponding rates at 100%, 100%, and 100% with a median follow-up of 19.6 months. Group 3 had the corresponding rates at 96.1%, 96.1%, and 96.1% with a median follow-up of 19.4 months.


CONCLUSIONS
The policy of a 6-month wait has benefited the HCC patients who practically had no chance of undergoing living-donor LT. Their survival outcomes will be excellent as long as they can stand the test of time.
1 Department of Surgery, The University of Hong Kong, Hong Kong, China. 2 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China. 3 Address correspondence to: Prof. See Ching Chan, 102 Pok Fu Lam Road, Hong Kong, China.
See Ching
SC
Chan
William W
WW
Sharr
Kenneth S H
KS
Chok
Albert C Y
AC
Chan
Chung Mau
CM
Lo
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult