title: List and liver transplant survival according to waiting time in patients with hepatocellular carcinoma.
abstract: The time that patients with hepatocellular carcinoma (HCC) can safely remain on the waiting list for liver transplantation (LT) is unknown. We investigated whether waiting time on the list impacts transplant survival of HCC candidates and transplant recipients. This is a single-center retrospective study of 283 adults with HCC. Patients were divided in groups according to waiting-list time. The main endpoint was survival. The median waiting time for LT was 4.9 months. The dropout rates at 3-, 6-, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Mortality on the list was 4.8%, but varied depending of the time on the list. Patients who waited less than 3-months had an inferior overall survival when compared to the other groups (p = 0.027). Prolonged time on the list significantly reduced mortality in this analysis (p = 0.02, HR = 0.28). Model for End Stage Liver Disease (MELD) score at transplantation did also independently impact overall survival (p = 0.03, HR = 1.06). MELD was the only factor that independently impacted posttransplant survival (p = 0.048, HR = 1.05). We conclude that waiting time had no relation with posttransplant survival. It is beneficial to prolong the waiting list time for HCC candidates without having a negative impact in posttransplant survival.
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: P R
authors: PR
authors: Salvalaggio
authors: G
authors: G
authors: Felga
authors: D A
authors: DA
authors: Axelrod
authors: B
authors: B
authors: Della Guardia
authors: M D
authors: MD
authors: Almeida
authors: M B
authors: MB
authors: Rezende
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014850:Waiting Lists
keywords: Clinical research; cancer; classification; hepatology; liver disease: malignant; liver transplantation; malignancy; neoplasia; organ allocation; practice; systems: Milan criteria; waitlist management