Are Patients with Child's A Cirrhosis and Hepatocellular Carcinoma Appropriate Candidates for Liver Transplantation?

• Published in: American journal of transplantation Vol. 12; no. 3; pp. 706 - 717
• Main Authors: Berry, K., Ioannou, G. N.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.03.2012; Wiley
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Child; Child’s A Cirrhosis; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; hepatocellular carcinoma; Humans; Liver Cirrhosis - classification; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Middle Aged; Other diseases. Semiology; posttransplantation survival; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; survival benefit; Survival Rate; Treatment Outcome; Young Adult; Human; Prognosis; Digestive system; survival benefit; Liver; Hepatic disease; Hepatocellular carcinoma; Patient; Malignant tumor; Homotransplantation; Survival; Recommendation; Liver cancer; Cirrhosis; Treatment; Surgery; Child's A Cirrhosis; Graft; Digestive diseases; Child; posttransplantation survival; Cancer; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03853.x

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. Liver transplantation in patients with stage II hepatocellular carcinoma and Child's A cirrhosis results in a very low survival benefit and may not constitute optimal use of scarce liver donor organs.