Estimation of the Harm to the Waiting List as a Crucial Factor in the Selection of Patients With Hepatocellular Carcinoma for Liver Transplantation

• Published in: Transplantation proceedings Vol. 42; no. 4; pp. 1194 - 1196
• Main Authors: Vitale, A, Volk, M.L, Gambato, M, Zanus, G, D'Amico, F, Carraro, A, Pauletto, A, Bonsignore, P, Scopelliti, M, Polacco, M, Russo, F, Senzolo, M, Burra, P, Romano, A, Angeli, P, Cillo, U
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.05.2010; Elsevier
• Subjects: Biological and medical sciences; Carcinoma, Hepatocellular - surgery; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver Transplantation - statistics & numerical data; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Markov Chains; Medical sciences; Patient Selection; Predictive Value of Tests; Prognosis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Survivors; Time Factors; Tissue, organ and graft immunology; Tumors; Waiting Lists; Human; Digestive system; Estimation; Liver; Selection; Hepatic disease; Hepatocellular carcinoma; Patient; Malignant tumor; Homotransplantation; Medicine; Liver cancer; Treatment; Surgery; Danger; Digestive diseases; Graft; Waiting list; Cancer; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.03.089

Abstract Background Long-term survival rates after orthotopic liver transplantation (OLT) for patients with hepatocellular carcinoma (HCC) of any size and number may now be predicted using the Metroticket calculator. The aim of this study was to evaluate the minimum post-OLT survival threshold that would justify the selection of a patient with HCC for OLT. Methods We used a Markov model, recently developed at the University of Michigan, which assumes that a patient with HCC should undergo OLT if his or her transplant benefit is greater than the cumulative harm to the rest of the waiting list (WL). In the base case, we considered a patient with a low survival perspective without OLT (5-year survival rate, 10%). The data sources to construct and validate the model were as follows: the Organ Procurement and Transplantation Network report, and our prospective database. Results Our center was generally characterized by lower WL mortalities, although there were lower transplant probabilities for both HCC and non-HCC patients than the average US center. The proportion of HCC patients on the WL was higher in Padua (25%) than in the United States (10%). The calculated harm to the WL was 434 quality-adjusted days of life in Padua, and 957 in the United States ( P < .01). The OLT benefit outweighed the harm to the WL when the 5-year post-OLT survival rate was higher than 30% in Padua, and 61% in the United States. Conclusions In a decision model including the concepts of transplantation benefit and harm to the WL, the minimum 5-year post-OLT survival threshold justifying the selection of a patient with HCC for OLT in Padua was 30%.