Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm.
Journal Article (Journal Article)
Liver transplant allocation policy does not give model for end-stage liver disease (MELD) exception points for patients with a single hepatocellular carcinoma (HCC) <2 cm in size, but does give points to patients with multiple small nodules. Because standard-of-care imaging for HCC struggles to differentiate HCC from other nodules, it is possible that a subset of patients receiving liver transplant for multiple nodules <2 cm in size does not have HCC. We evaluate risk of post-transplant HCC recurrence and wait-list dropout for patients with multiple small nodules using competing risks regression based on the Fine and Gray model. We identified 5002 adult HCC patients in the OPTN/UNOS dataset diagnosed and transplanted between January 2006 and September 2010. Compared to patients with >1 tumor <2 cm, risk of developing recurrence was significantly higher in patients with one or more tumors with only one tumor ≥2 cm (SHR 1.63, p = 0.009), as well as in patients with 2-3 tumors ≥2 cm (SHR 1.84, p = 0.02). Dropout risk was not significantly different among size categories. HCC recurrence risk was significantly lower in patients with multiple nodules <2 cm in size than in those with larger tumors, supporting the possibility that some patients received unnecessary transplants. The priority given to these patients must be re-examined.
Full Text
Duke Authors
Cited Authors
- Samoylova, ML; Dodge, JL; Mehta, N; Yao, FY; Roberts, JP
Published Date
- January 2015
Published In
Volume / Issue
- 29 / 1
Start / End Page
- 52 - 59
PubMed ID
- 25366656
Pubmed Central ID
- 25366656
Electronic International Standard Serial Number (EISSN)
- 1399-0012
International Standard Serial Number (ISSN)
- 0902-0063
Digital Object Identifier (DOI)
- 10.1111/ctr.12480
Language
- eng