title: HCC patients suffer less from geographic differences in organ availability.
abstract: It has been suggested that the number of exception model for end-stage liver disease (MELD) points for hepatocellular carcinoma (HCC) overestimates mortality risk. Average MELD at transplant, a measure of organ availability, correlates with mortality on an intent-to-treat basis and varies by donation service area (DSA). We analyzed Scientific Registry of Transplant Recipients data from 2005 to 2010, comparing transplant and death parameters for patients transplanted with HCC exception points to patients without HCC diagnosis (non-HCC), to determine whether the two groups were impacted differentially by DSA organ availability. HCC candidates are transplanted at higher rates than non-HCC candidates and are less likely to die on the waitlist. Overall risk of death trends downward by 1% per MELD point (p = 0.65) for HCC, but increases by 7% for non-HCC patients (p < 0.0001). The difference in the change of mortality with MELD is statistically significant between HCC and non-HCC candidates p < 0.0001. Posttransplant risk of death trends downward by 2% per MELD point (p = 0.28) for HCC patients, but increases by 3% per MELD point in non-HCC patients (p = 0.027), with the difference being statistically significant with p < 0.005. In summary, increasing wait time impacts HCC candidates less than non-HCC candidates and under increased competition for donor organs, HCC candidates' advantage increases.
authors.affiliation: Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, MA.
authors.forename: C
authors.initials: C
authors.lastname: Schuetz
authors.forename: N
authors.initials: N
authors.lastname: Dong
authors.forename: E
authors.initials: E
authors.lastname: Smoot
authors.forename: N
authors.initials: N
authors.lastname: Elias
authors.forename: D A
authors.initials: DA
authors.lastname: Schoenfeld
authors.forename: J F
authors.initials: JF
authors.lastname: Markmann
authors.forename: H
authors.initials: H
authors.lastname: Yeh
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D014850:Waiting Lists / Q000401:mortality
keywords: Hepatocellular carcinoma; MELD score; donation service area; liver transplantation; organ allocation