INTRODUCTION OF NATIONAL LIVER REVIEW BOARD IS ASSOCIATED WITH A DECREASE IN HEPATOCELLULAR CARCINOMA OUTSIDE MILAN CRITERIA ON EXPLANT ANALYSIS

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: In May 2019, a national liver review board (NLRB) replaced regional review boards to evaluate liver transplant (LT) patients with hepatocellular carcinoma (HCC) patient for exception MELD scores. Aims of the NLRB were to standardize the exception process and reduce disparities in transplant opportunities. The aim of this study is to evaluate the outcome of these policy changes on HCC explant pathology. Methods: OPTN UNOS database was queried for LT patients listed with HCC exception from Jan. 1, 2016 to Dec. 31, 2021. Patients were divided into 2 groups (pre-NLRB era, post-NLRB era) according to a registration date before or after May 14, 2019. Using explant data, the proportion of patients outside Milan criteria (single tumor <5cm or 2-3 tumors all <3cm, and without vascular invasion) were compared between eras. Lesions identified with 100% necrosis were not counted as HCC lesions. As a subgroup analysis, transplant regions were divided into 2 groups based on the approval of HCC exception prior to the NLRB: a high outside standard criteria group (>=50% did not meet standard criteria at approval) and low outside standard criteria group (<50% did not meet standard criteria at approval). Explant data were compared separately between these groups in both eras. Results: The study cohort included 6,175 LT patients with HCC with 4,429 in the pre-and 1,746 patients in the post-NLRB era. In the two eras, there was no significant difference between median laboratory MELD scores at registration (9.0 [7.0-12.0] and 9.0 [7.0-21.0]) and at transplantation (10.0 [8.0-14.0] and 10.0[8.0-13.0], respectively). Using explant data, the proportion of HCC outside Milan significantly decreased after policy change from 1,176 (26.6%) to 406 (23.3%) with an odds ratio (OR) of 0.838 (p=0.007). In the subgroup analysis, in the low outside standard criteria group, the proportion of HCC outside Milan on explant did not change between pre-and post-NLRB eras (25.9% to 24.5%: p=0.374). Conversely, in the high outside standard criteria group, there was a significant decline in HCC outside Milan from 27.4% to 21.3% after introduction of the NLRB (OR, 0.718; p=0.002). Conclusion: Our results suggest that introduction of the NLRB was associated with a decrease in HCC outside Milan criteria on explant and reduced disparities in LT access for HCC.

Volume

76

First Page

S526

Last Page

S527

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