Liver transplantation for hepatocellular carcinoma: Impact of wait time at a single center

William C. Palmer, David Lee, Justin Burns, Kristopher Croome, Barry Rosser, Tushar C Patel, Andrew P. Keaveny, Surakit Pungpapong, Raj Satyanarayana, Maria Yataco, Raouf Nakhleh, Kaitlyn R. Musto, Alexandra M. Canabal, Alex K. Turnage, David O. Hodge, Justin H Nguyen, Denise Harnois

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Introduction and aim. Liver transplantation (LT) provides durable survival for hepatocellular carcinoma (HCC). However, there is continuing debate concerning the impact of wait time and acceptable tumor burden on outcomes after LT. We sought to review outcomes of LT for HCC at a single, large U.S. center, examining the influence of wait time on post-LT outcomes. Material and methods. We reviewed LT for HCC at Mayo Clinic in Florida from 1/1/2003 until 6/30/2014. Follow up was updated through 8/1/ 2015. Results. From 2003-2014, 978 patients were referred for management of HCC. 376 patients were transplanted for presumed HCC within Milan criteria, and the results of these 376 cases were analyzed. The median diagnosis to LT time was 183 days (8 - 4,337), and median transplant list wait time was 62 days (0 - 1815). There was no statistical difference in recurrence-free or overall survival for those with wait time of less than or greater than 180 days from diagnosis of HCC to LT. The most important predictor of long term survival after LT was HCC recurrence (HR: 18.61, p < 0.001). Recurrences of HCC as well as survival were predicted by factors related to tumor biology, including histopathological grade, vascular invasion, and pre-LT serum alpha-fetoprotein levels. Disease recurrence occurred in 13%. The overall 5-year patient survival was 65.8%, while the probability of 5-year recurrence- free survival was 62.2%. Conclusions. In this large, single-center experience with long-term data, factors of tumor biology, but not a longer wait time, were associated with recurrence-free and overall survival.

Original languageEnglish (US)
Pages (from-to)402-411
Number of pages10
JournalAnnals of Hepatology
Volume16
Issue number3
DOIs
StatePublished - 2017

Keywords

  • Clinical outcomes
  • Hepatocellular carcinoma
  • Liver transplantation

ASJC Scopus subject areas

  • Hepatology

Fingerprint Dive into the research topics of 'Liver transplantation for hepatocellular carcinoma: Impact of wait time at a single center'. Together they form a unique fingerprint.

  • Cite this

    Palmer, W. C., Lee, D., Burns, J., Croome, K., Rosser, B., Patel, T. C., Keaveny, A. P., Pungpapong, S., Satyanarayana, R., Yataco, M., Nakhleh, R., Musto, K. R., Canabal, A. M., Turnage, A. K., Hodge, D. O., Nguyen, J. H., & Harnois, D. (2017). Liver transplantation for hepatocellular carcinoma: Impact of wait time at a single center. Annals of Hepatology, 16(3), 402-411. https://doi.org/10.5604/16652681.1235483