Patient-reported outcomes in liver transplant recipients with hepatocellular carcinoma.
The effect of awarding MELD exception points for hepatocellular carcinoma (HCC) on patient-reported outcomes (PROs) is unknown. We evaluated the physical and mental health-related quality of life (HRQOL) and symptoms of anxiety and depression in liver transplant recipients with HCC compared to patients without HCC.



The single-center sample measured PROs before and after transplant, which included 1521 multisurvey measurement points among 502 adults (67% male, 28% HCC, follow-up time: <1-131 months). Data were analyzed using multivariable mixed-effects models.



Longitudinal PRO values did not differ between persons who received HCC exception points and those who did not have HCC. Patients with HCC who did not receive exception points had reduced physical HRQOL (P=.016), a late decline in mental HRQOL, and delayed reduction in anxiety (time-by-outcome interaction P<.050) compared to patients with HCC who received exception points.



Transplant recipients who received HCC exception points had PROs that were comparable to those of patients without HCC, and reported better physical HRQOL and reduced symptoms of anxiety compared to patients with HCC who did not receive exception points. These analyses demonstrate the impact of HCC exception points on PROs, and may help inform policy regarding HCC exception point allocation.
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Transplant Center, Nashville, TN, USA.
Clark D
CD
Kensinger
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Transplant Center, Nashville, TN, USA.|Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
Irene D
ID
Feurer
Vanderbilt Transplant Center, Nashville, TN, USA.
Heather W
HW
O'Dell
Vanderbilt Transplant Center, Nashville, TN, USA.
David C
DC
LaNeve
Vanderbilt Transplant Center, Nashville, TN, USA.
Lindsey
L
Simmons
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Transplant Center, Nashville, TN, USA.
C Wright
CW
Pinson
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. derek.moore@vanderbilt.edu.|Vanderbilt Transplant Center, Nashville, TN, USA. derek.moore@vanderbilt.edu.
Derek E
DE
Moore
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D018579:Patient Selection; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000379:methods*; D066027:Transplant Recipients; D014850:Waiting Lists
Model for End-Stage Liver Disease; exception points; health-related quality of life; multivariable models; organ transplant