An Intention-To-Treat Analysis of Liver Transplantation for Hepatocellular Carcinoma Using Organ Procurement Transplant Network Data

摘要

Single-center studies have shown acceptable long-term outcomes following orthotopic liver transplantation (OLT) forhepatocellular carcinoma (HCC) when tumors are within the Milan criteria. However, the overall survival and waiting listremoval rates have not been described at a national level with pooled registry data. To evaluate this, a retrospective cohort ofpatients listed for OLT with a diagnosis of HCC between January 1998 and March 2006 was identified from Organ ProcurementTransplant Network data. Analysis was performed from the time of listing. Adjusted Cox models were used to assess therelative effect of potential confounders on removal from the waiting list as well as survival from the time of wait listing. A totalof 4482 patients with HCC were placed on the liver waiting list during the study peridd. Of these, 65% underwenttransplantation, and 18% were removed from the list because of tumor progression or death. The overall 1- and 5-yearintent-to-treat survival for all patients listed was 81% and 51%, respectively. The 1- and 5-year survival was 89% and 61% forthose 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 criteriafor liver transplantation of candidates with HCC lead to acceptable 5-year survival while limiting the dropout rate.