Conflict of interest: None of the authors have financial or other potential conflicts of interest with any companies/organizations whose products or services are discussed in this manuscript.
Risk factors for liver transplant waitlist dropout in patients with hepatocellular carcinoma
Version of Record online: 13 JUN 2012
© 2012 John Wiley & Sons A/S
Volume 26, Issue 4, pages E359–E364, July/August 2012
How to Cite
Park S-J, Freise CE, Hirose R, Kerlan RK, Yao FY, Roberts JP, Vagefi PA. Risk factors for liver transplant waitlist dropout in patients with hepatocellular carcinoma.
- Issue online: 8 AUG 2012
- Version of Record online: 13 JUN 2012
- Manuscript Accepted: 13 APR 2012
- hepatocellular carcinoma;
- liver transplantation;
- waitlist dropout;
- loco-regional therapy;
- MELD ;
- MELD exception points
Loco-regional therapy has been developed to reduce waitlist dropout in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation. We evaluated the probability of transplantation and waitlist dropout, and analyzed risk factors for waitlist dropout, in 76 patients with HCC from September 2004 to August 2006. Seventy-three (96.1%) patients received one or more preoperative loco-regional treatments and 55 (72.3%) received an orthotopic liver transplantation with a median wait time of seven months (range, 2–26 months). There were 11 dropouts (14.5%) associated with tumor progression or hepatic decompensation (median waiting time; 5.4 months and range, 0.4–13 months). Cumulative probabilities of transplantation at three, six, nine, 12, 15, and 18 months were 5.4%, 35.4%, 67.5%, 78.8%, 80.7%, and 80.7%, respectively and those of waitlist dropout at three, six, nine, 12, 15, and 18 months were 3.9%, 8.7%, 12.8%, 22.9%, 29.3%, and 29.3%, respectively. A laboratory model for end-stage liver disease (MELD) score >15 or multiple tumors at the time of UNOS listing were significant risk factors for waitlist dropout (p = 0.006 and 0.026, respectively). Patients with HCC being managed with loco-regional therapy who have a laboratory MELD score >15 or multiple tumors should be considered for earlier access to liver transplantation to prevent waitlist dropout.