Liver Transplants @ Hepatocellular Carcinoma

LIVER TRANSPLANT PATIENTS and HEPATOCELLULAR CARCINOMA:
"Liver transplantation allocation to patients with hepatocellular carcinoma." Abstract 104, Dawwas. Liver transplantation is considered to be within the standard of care for patients with hepatocellular carcinoma who fall within the UNOS and MILAN criteria. In this abstract, a liver transplant data base was evaluated in the UK and Ireland for survival characteristics for patients with HCC who underwent liver transplantation with donor organs from high risk patients. The authors described that donor organ quality had a significant impact on the outcome (patient and graft survival) after liver transplantation for HCC. They identified that high-risk donor organs could be preferentially allocated to HCC patients, and resulted in patients having a similar long-term survival when higher risk organs were used compare to normal risk donors. This equivalency was attributed to 2 facts: 1) these patients had access to organs at an earlier time point, after HCC was diagnosed and thus were less ill with a lower medical MELD score and could thus 2) tolerate periods of liver graft dysfunction better. High-risk organs account for approximately 15% of organ donors within this UK/Ireland data base. This publication provides support that expanding organ access through the use of high risk organs and careful allocation may allow more patients to undergo liver transplant for HCC to decrease the wait list removal for disease progression. "The effect of local regional therapy for hepatocellular carcinoma prior to liver transplantation." Abstract 150-AASLD, Mobley. This study was a retrospective analysis of the Organ Procurement Transplant Network (OPTN) database. This review was performed to determine if RFA or TACE, performed for the diagnosis of HCC in patients listed for liver transplant, led to improved survival on the waiting list and after liver transplantation. Importantly, when controlling for confounding factors, those patients who received local/regional therapy such as TACE or RFA, prior to listing, independently predicted improved survival during the follow-up period, with observation of 0.694. This survival benefit included both the period on the waiting list and after liver transplantation. This analysis provides strong support, due the study size and extent, that ablative interventions results in improved wait list survival and cancer free survival after liver transplantation. "Outcome following salvage liver transplantation for recurrent hepatocellular carcinoma after resection." Abstract 585-AASLD, Hange. Liver transplantation is the best treatment for hepatocellular carcinoma in patients with cirrhosis and portal hypertension, since it offers the only substantial long-term chance of cure. In this study, patients who had hepatocellular carcinoma fit the profile where a hepatic resection could take place, which is typical in patients with very early cirrhosis, where there is minimal evidence of portal hypertension and were Class 0 utilizing the BCLC staging system. In this study, review of the OPTN and UNOS data bases suggested that liver transplantation after liver resection, for recurrent HCC disease, showed similar short-term post-transplant survival as compared to those patients undergoing primary liver transplantation for HCC. This is an important finding that may further expand those patients who are candidates for LT. This study was limited by a small number of patients but provides support that we, as clinicians, should evaluate patients for liver transplantation after hepatic resection for those patients who have recurrent hepatocellular carcinoma.