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Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm.

Publication ,  Journal Article
Samoylova, ML; Dodge, JL; Mehta, N; Yao, FY; Roberts, JP
Published in: Clinical transplantation
January 2015

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.

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Published In

Clinical transplantation

DOI

EISSN

1399-0012

ISSN

0902-0063

Publication Date

January 2015

Volume

29

Issue

1

Start / End Page

52 / 59

Related Subject Headings

  • Waiting Lists
  • Tumor Burden
  • Treatment Outcome
  • Surgery
  • Severity of Illness Index
  • Risk Assessment
  • Patient Selection
  • Neoplasm Recurrence, Local
  • Models, Statistical
  • Middle Aged
 

Citation

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Samoylova, M. L., Dodge, J. L., Mehta, N., Yao, F. Y., & Roberts, J. P. (2015). Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm. Clinical Transplantation, 29(1), 52–59. https://doi.org/10.1111/ctr.12480
Samoylova, Mariya L., Jennifer L. Dodge, Neil Mehta, Francis Y. Yao, and John P. Roberts. “Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm.Clinical Transplantation 29, no. 1 (January 2015): 52–59. https://doi.org/10.1111/ctr.12480.
Samoylova ML, Dodge JL, Mehta N, Yao FY, Roberts JP. Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm. Clinical transplantation. 2015 Jan;29(1):52–9.
Samoylova, Mariya L., et al. “Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm.Clinical Transplantation, vol. 29, no. 1, Jan. 2015, pp. 52–59. Epmc, doi:10.1111/ctr.12480.
Samoylova ML, Dodge JL, Mehta N, Yao FY, Roberts JP. Evaluating the validity of model for end-stage liver disease exception points for hepatocellular carcinoma patients with multiple nodules <2 cm. Clinical transplantation. 2015 Jan;29(1):52–59.
Journal cover image

Published In

Clinical transplantation

DOI

EISSN

1399-0012

ISSN

0902-0063

Publication Date

January 2015

Volume

29

Issue

1

Start / End Page

52 / 59

Related Subject Headings

  • Waiting Lists
  • Tumor Burden
  • Treatment Outcome
  • Surgery
  • Severity of Illness Index
  • Risk Assessment
  • Patient Selection
  • Neoplasm Recurrence, Local
  • Models, Statistical
  • Middle Aged