An intention-to-treat analysis of liver transplantation for hepatocellular carcinoma using organ procurement transplant network data
Open Access
- 29 July 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 15 (8), 859-868
- https://doi.org/10.1002/lt.21778
Abstract
Single‐center studies have shown acceptable long‐term outcomes following orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) when tumors are within the Milan criteria. However, the overall survival and waiting list removal rates have not been described at a national level with pooled registry data. To evaluate this, a retrospective cohort of patients listed for OLT with a diagnosis of HCC between January 1998 and March 2006 was identified from Organ Procurement Transplant Network data. Analysis was performed from the time of listing. Adjusted Cox models were used to assess the relative effect of potential confounders on removal from the waiting list as well as survival from the time of wait listing. A total of 4482 patients with HCC were placed on the liver waiting list during the study period. Of these, 65% underwent transplantation, and 18% were removed from the list because of tumor progression or death. The overall 1‐ and 5‐year intent‐to‐treat survival for all patients listed was 81% and 51%, respectively. The 1‐ and 5‐year survival was 89% and 61% for those listed with tumors meeting the Milan criteria versus 70% and 32% for those exceeding the Milan criteria (P < 0.0001). On multivariate analysis, advanced liver failure manifested by Child‐Pugh class B or C increased the risk of death, while age < 55 years, meeting the Milan criteria, and obtaining a liver transplant were associated with better survival. The current criteria for liver transplantation of candidates with HCC lead to acceptable 5‐year survival while limiting the dropout rate. Liver Transpl 15:859–868, 2009. © 2009 AASLD.Keywords
Funding Information
- DK (064909)
This publication has 20 references indexed in Scilit:
- Management of hepatocellular carcinomaHepatology, 2005
- Resection and Liver Transplantation for Hepatocellular CarcinomaSeminars in Liver Disease, 2005
- Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survivalHepatology, 2001
- Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosisHepatology, 2001
- Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: Resection versus transplantationHepatology, 1999
- Rising Incidence of Hepatocellular Carcinoma in the United StatesThe New England Journal of Medicine, 1999
- Liver Transplantation for Hepatocellular CarcinomaSeminars in Liver Disease, 1999
- Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with CirrhosisThe New England Journal of Medicine, 1996
- Hepatic Resection Versus Transplantation for Hepatocellular CarcinomaAnnals of Surgery, 1991
- Surgical treatment of hepatocellular carcinoma: Experience with liver resection and transplantation in 198 patientsWorld Journal of Surgery, 1991