Are Patients with Child's A Cirrhosis and Hepatocellular Carcinoma Appropriate Candidates for Liver Transplantation?
Article first published online: 28 NOV 2011
© copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 12, Issue 3, pages 706–717, March 2012
How to Cite
Berry, K. and Ioannou, G. N. (2012), Are Patients with Child's A Cirrhosis and Hepatocellular Carcinoma Appropriate Candidates for Liver Transplantation?. American Journal of Transplantation, 12: 706–717. doi: 10.1111/j.1600-6143.2011.03853.x
- Issue published online: 28 FEB 2012
- Article first published online: 28 NOV 2011
- Received 25 August 2011, revised 26 September 2011 and accepted for publication 06 October 2011
- Child’s A Cirrhosis;
- hepatocellular carcinoma;
- liver transplantation;
- posttransplantation survival;
- survival benefit
We aimed to estimate the survival benefit derived from transplantation in patients with stage II hepatocellular carcinoma (HCC) and Child's A cirrhosis, defined as the mean lifetime with transplantation minus the mean lifetime with treatments other than transplantation. We calculated the posttransplantation survival of all adult, first-time, deceased-donor, liver transplant recipients in the United States since the introduction of the Model for End-Stage Liver Disease based priority system in February 2002 (n = 36 791). We estimated the posttreatment survival of patients with Child's A cirrhosis and stage II HCC treated by radiofrequency ablation (RFA) ± transarterial chemoembolization (TACE) or surgical resection by conducting a systematic review of the medical literature. In patients with Child's A cirrhosis and stage II HCC, the estimated median survival benefit of liver transplantation compared to RFA ± TACE was 1.5 months at 3 years (range −3.5 to 5.6) and 5.7 months at 5 years (range 0.7–11.4), whereas compared to surgical resection it was 0.7 months at 3 years (range −2.9 to 3) and 2.8 months at 5 years (range −4.4 to 5.7). Liver transplantation in patients with stage II HCC and Child's A cirrhosis results in a very low survival benefit and may not constitute optimal use of scarce liver donor organs.