OUTCOMES FOR LIVER TRANSPLANT PATIENTS WITH HEPATOCELLULAR CARCINOMA BASED ON TUMOR EXPLANT PATHOLOGY

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: Patients listed for liver transplant (LT) with hepatocellular carcinoma (HCC) must meet HCC size criteria (T2 or Milan criteria) in order to receive the standard HCC MELD exception. However, even among these patients, HCC exceeding Milan criteria is frequently found on explant analysis. Post-transplant outcomes based on explant findings are not well studied using OPTN UNOS data. The current study aims to determine post-transplant outcomes according to explant HCC findings in those who met T2 criteria and received MELD exception. Methods: UNOS dataset was queried for adult LT patients with standard HCC exception from Apr. 8th, 2012, to Dec. 31st, 2021. Explant data was evaluated to identify patients 1) T2 (single tumor <5cm or 2-3 tumors all <3cm), 2) bilobar disease, 3) vascular invasion, 4) poor differentiation, and 5) satellite lesion. Lesions identified with 100% necrosis were not counted as HCC lesion(s). The prognostic effects of explant factors on 5-year patient survival were evaluated. Results: The study cohort included 6,779 patients who underwent LT with the standard HCC exception. According to explant pathology findings, 1,231 (18.2%), 1,511 (22.3%) 841 (13.3%), 423 (6.2%), and 354 (5.2%) patients had HCC(s) outside T2, bilobar disease, with vascular invasion, poor differentiation, and satellite lesions respectively. 5-year patient survival rates in patients with HCC outside criteria were significantly worse than in those with HCC within criteria (T2; 71.4% vs 81.5%, bilobar; 76.0% vs 80.7%, vascular invasion; 70.9% vs 81.0%, poor differentiation; 62.4% vs 81.0%, and satellite lesion; 73.6% vs 80.0%, p<0.001). With multivariable cox regression, poor differentiation (HR2.1 95%Cl: 1.73-2.59 p<0.001), outside T2 (HR1.5 95%Cl: 1.28-1.79 p<0.001), and vascular invasion (HR1.3 95%Cl: 1.06-1.52 p=0.01) were associated with poor patient survival. In addition, among patient within explant T2 criteria, poor differentiation (HR2.2 95%Cl: 1.76-2.63 p<0.001), vascular invasion (HR1.4 95%Cl: 1.17-1.66 p<0.001), and bilobar disease (HR1.2 95%Cl: 1.02-1.40 p=0.024) were associated with poor patient survival. Conclusion: Patients with lesions outside T2 criteria had significantly worse five year survival than those within. Focusing on patients meeting standard exception criteria on explant, poor differentiation, vascular invasion, and bilobar disease are factors associated with worse patient survival.

Volume

76

First Page

S524

Last Page

S525

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