title: Intent-to-treat analysis of liver transplant for hepatocellular carcinoma in the MELD era: impact of hepatitis C and advanced status.
abstract: OBJECTIVE
  Liver transplantation is a well-recognized treatment for non-resectable hepatocellular carcinoma (HCC); however, the overall survival and waiting list removal rates for hepatitis C virus (HCV)-related HCC have not been assessed.
  
  
  METHODS
  The present study included 11,146 patients with HCC and 64,788 patients without HCC, listed for liver transplantation on the Scientific Registry of Transplant Recipients database between 2003 and 2010.
  
  
  RESULTS
  In a multivariate analysis, HCV infection was an independent predictor of being transplanted or remaining on the waiting list in HCC candidates (HR 0.65, 95% CI 0.60-0.71, p < 0.001). However, patients in the advanced status (model for end-stage liver disease score over 20, tumor stage exceed tumor-node-metastasis stage II, or alpha fetoprotein lover 400 ng/ml) but without HCV had better post-transplant survival than patients in the advanced status and with HCV (64 vs. 47% at 5 years, p < 0.001), and comparable survival to patients with HCV but not in the advanced status (62%, p = 0.461).
  
  
  CONCLUSIONS
  HCC candidates with HCV infection are more likely to be transplanted, remain on the waiting list for longer, and have worse post-transplant survival. Patients in the advanced status but without HCV also could share a similar post-transplant survival to those not in the advanced status but with HCV.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Key Laboratory of Combined Multi-organ Transplantation Ministry of Public Health Key Laboratory of Organ Transplantation, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China, huzhenh@zju.edu.cn.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Hu
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Li
authors.forename: Jie
authors.initials: J
authors.lastname: Xiang
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.forename: Sheng
authors.initials: S
authors.lastname: Yan
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D005260:Female; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D017093:Liver Failure / Q000628:therapy*; D008113:Liver Neoplasms / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors; D014850:Waiting Lists