title: Screening for liver cancer during transplant waiting list: a multicenter study from South America.
abstract: OBJECTIVE
  Surveillance during liver transplantation (LT) waiting list has scarcely been reported in South America. We aimed to describe hepatocellular carcinoma (HCC) surveillance during the LT waiting list in the daily practice.
  
  
  METHODS
  A multicenter retrospective analysis in cirrhotic patients was carried out. All patients underwent an ultrasound (US) every 6 months and the last pre-LT US was compared with explanted liver findings. A false-negative case was considered when incidentally found HCC (iHCC) was detected, whereas a false-positive case was considered when HCC diagnosed before LT (cHCC) was not confirmed in the explanted liver. US performance was assessed after excluding cHCC patients referred to transplant evaluation.
  
  
  RESULTS
  Of 643 patients, 129 had HCC, of whom 92 had cHCC (71.3%) and 37 had iHCC (28.7%). Five patients (5.4%) had nonconfirmed cHCC (n=3 regenerative nodules, n=1 biliary hamartoma, and n=1 cholangiocarcinoma). Patients with iHCC had a higher MELD score (23±10 vs. 15±10; P<0.0001), and were more frequently Child-Pugh C (62.2 vs. 36.6%; P=0.006) compared with patients with cHCC. The number of US performed during waiting list was 1.7±1.6 (median 1.0). During transplant waiting list, the sensitivity and specificity of US were 33 and 99%, with positive and negative predictive values of 0.89 and 0.93, respectively. Multivariate analysis showed that the strongest variable related to iHCC finding was pre-LT Child-Pugh C status (OR 3.5; P=0.004).
  
  
  CONCLUSIONS
  Screening for liver cancer remains an important issue during transplant waiting list. However, the US screening method should be reviewed particularly for Child-Pugh C patients.
authors.affiliation: aHepatology and Liver Transplant Unit bDepartment of Internal Medicine, Hospital Universitario Austral cLiver Transplant Program, Hospital Italiano from Buenos Aires dLiver Transplant Unit, Hospital Alemán, Buenos Aires eLiver Transplant Unit, Sanatorio Allende, Córdoba, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.forename: Sebastián
authors.initials: S
authors.lastname: Marciano
authors.forename: Margarita
authors.initials: M
authors.lastname: Anders
authors.forename: Federico
authors.initials: F
authors.lastname: Orozco
authors.forename: Alina
authors.initials: A
authors.lastname: Zerega
authors.forename: Carla Ramirez
authors.initials: CR
authors.lastname: Cabrera
authors.forename: Matías Tisi
authors.initials: MT
authors.lastname: Baña
authors.forename: Octavio
authors.initials: O
authors.lastname: Gil
authors.forename: Oscar
authors.initials: O
authors.lastname: Andriani
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.forename: Lucas
authors.initials: L
authors.lastname: McCormack
authors.forename: Adrián
authors.initials: A
authors.lastname: Gadano
authors.forename: Marcelo
authors.initials: M
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016031:Liver Transplantation; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014463:Ultrasonography; D014850:Waiting Lists; D055815:Young Adult