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Author Notes:

E-mail address: smaithe@emory.edu.

No conflict of interest disclosure

Subjects:

Research Funding:

This study was supported in part by the Katz Foundation.

National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Surgery
  • waitlist time
  • liver transplant
  • hepatocellular carcinoma
  • hepatic resection
  • Milan Criteria
  • LONG-TERM SURVIVAL
  • HEPATITIS-C VIRUS
  • TO-TREAT ANALYSIS
  • LIVER RESECTION
  • RECURRENCE
  • THERAPY
  • INFECTION
  • CIRRHOSIS
  • OUTCOMES
  • BENEFIT

Transplant versus resection for the management of hepatocellular carcinoma meeting Milan Criteria in the MELD exception era at a single institution in a UNOS region with short wait times

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Journal Title:

Journal of Surgical Oncology

Volume:

Volume 109, Number 6

Publisher:

, Pages 533-541

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: Management of hepatocellular carcinoma (HCC) in the Model for End-Stage Liver Disease (MELD) exception era remains regionally variable. Outcomes were compared for patients undergoing transplant versus resection at a single institution in a UNOS region with short wait times for organ availability. Methods: All patients who underwent resection of HCC from January 2000 to August 2012 and patients who underwent transplant post-January 2006, during the Milan Criteria (MC)-based MELD exception policy for HCC, were identified. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Results: Two hundred fifty-seven patients were analyzed, of whom 131 underwent transplant and 126 underwent resection. All transplant patients met MC; 45 (36%) resection patients met MC. Median follow-up time was 30 months. Median wait time to transplant was 55 days; no patients dropped off the waitlist while awaiting an organ. Among patients meeting MC, transplant demonstrated significantly greater 5-year OS (65.7% vs. 43.8%; P = 0.005) and RFS (85.3% vs. 22.7%; P < 0.001) versus resection. For patients with hepatitis C, transplant (n = 87) demonstrated significantly improved 5-year outcomes compared to patients meeting MC who underwent resection (n = 21; OS: 63.5% vs. 23.3%; P = 0.001; RFS: 83.5% vs. 23.7%; P < 0.001). Conclusion: In a region with short waitlist times for organ availability, liver transplant is associated with improved survival compared to resection for HCC within MC and should be considered for all patients meeting MC, particularly those with hepatitis C.

Copyright information:

© 2013 Wiley Periodicals, Inc.

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