Andreas Zori1, Faith Villanueva2, Diana Hatamleh3, Media Ismael3, Justin Forde3, Manoela Mota1, Lindsey Johnson3, Roniel Cabrera1. 1. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1600 SW Archer Rd, Gainesville, FL, USA. 2. Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, USA. faith.villanueva@medicine.ufl.edu. 3. Department of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, USA.
Abstract
BACKGROUND: Many patients are not candidates for liver transplant for non-tumor-related reasons including medical comorbidities and non-adherence. The prognosis of patients with hepatocellular carcinoma (HCC) who are not liver transplant candidates in the era of locoregional therapy (LRT) including y90 is not well defined. AIMS: This study seeks to evaluate outcomes and the natural history of early-stage HCC in patients who were denied liver transplant listing due to non-tumor reasons and instead were treated with LRT. METHODS: A retrospective evaluation was performed for all patients who completed liver transplant evaluation with their tumor within Milan criteria but were denied due to non-tumor reasons and were treated with LRT at a single tertiary referral center. RESULTS: The 61 patients included had a favorable overall survival, with a median survival 60.3 months (86.9% at 1 year and 52.7% at 5 years). Patients with Child-Pugh A cirrhosis (n = 34) had significantly longer overall survival compared to those with Child-Pugh B/C cirrhosis (median survival of 70.3 months versus 26.1 months, p = 0.005). Survival in patients with Child-Pugh A at 1, 3, and 5 years was 97%, 80%, and 73%, respectively, compared to 74%, 41%, and 31% in patients with Child-Pugh B/C. CONCLUSIONS: In a small single-center cohort, patients with HCC who were denied liver transplant due to non-tumor reasons and underwent LRT and had Child-Pugh A cirrhosis had survival approaching the national average for patients who undergo liver transplantation. Patients with Child-Pugh B/C cirrhosis had significantly worse outcomes than those with Child-Pugh A.
BACKGROUND: Many patients are not candidates for liver transplant for non-tumor-related reasons including medical comorbidities and non-adherence. The prognosis of patients with hepatocellular carcinoma (HCC) who are not liver transplant candidates in the era of locoregional therapy (LRT) including y90 is not well defined. AIMS: This study seeks to evaluate outcomes and the natural history of early-stage HCC in patients who were denied liver transplant listing due to non-tumor reasons and instead were treated with LRT. METHODS: A retrospective evaluation was performed for all patients who completed liver transplant evaluation with their tumor within Milan criteria but were denied due to non-tumor reasons and were treated with LRT at a single tertiary referral center. RESULTS: The 61 patients included had a favorable overall survival, with a median survival 60.3 months (86.9% at 1 year and 52.7% at 5 years). Patients with Child-Pugh A cirrhosis (n = 34) had significantly longer overall survival compared to those with Child-Pugh B/C cirrhosis (median survival of 70.3 months versus 26.1 months, p = 0.005). Survival in patients with Child-Pugh A at 1, 3, and 5 years was 97%, 80%, and 73%, respectively, compared to 74%, 41%, and 31% in patients with Child-Pugh B/C. CONCLUSIONS: In a small single-center cohort, patients with HCC who were denied liver transplant due to non-tumor reasons and underwent LRT and had Child-Pugh A cirrhosis had survival approaching the national average for patients who undergo liver transplantation. Patients with Child-Pugh B/C cirrhosis had significantly worse outcomes than those with Child-Pugh A.
Authors: Onur C Kutlu; Jennifer A Chan; Thomas A Aloia; Yun S Chun; Ahmed O Kaseb; Guillaume Passot; Suguru Yamashita; Jean-Nicolas Vauthey; Claudius Conrad Journal: Cancer Date: 2017-01-13 Impact factor: 6.860
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Authors: W R Kim; J R Lake; J M Smith; D P Schladt; M A Skeans; A M Harper; J L Wainright; J J Snyder; A K Israni; B L Kasiske Journal: Am J Transplant Date: 2018-01 Impact factor: 8.086
Authors: Riad Salem; Andrew C Gordon; Samdeep Mouli; Ryan Hickey; Joseph Kallini; Ahmed Gabr; Mary F Mulcahy; Talia Baker; Michael Abecassis; Frank H Miller; Vahid Yaghmai; Kent Sato; Kush Desai; Bartley Thornburg; Al B Benson; Alfred Rademaker; Daniel Ganger; Laura Kulik; Robert J Lewandowski Journal: Gastroenterology Date: 2016-08-27 Impact factor: 22.682
Authors: V Mazzaferro; E Regalia; R Doci; S Andreola; A Pulvirenti; F Bozzetti; F Montalto; M Ammatuna; A Morabito; L Gennari Journal: N Engl J Med Date: 1996-03-14 Impact factor: 176.079