Reduced Priority MELD Score for Hepatocellular Carcinoma Does Not Adversely Impact Candidate Survival Awaiting Liver Transplantation

Abstract Background Although criteria for liver transplantation, such as the Milan criteria and Hangzhou experiences, have become popular, criteria to guide adjuvant therapy for patients with hepatocellular carcinoma after liver transplantation are lacking. Methods We collected data from all consecutive patients from 2012 to 2019 at three liver transplantation centers in China retrospectively. Univariate and multivariate analyses were used to analyze preoperative parameters, such as demographic and clinical data. Using data obtained in our center, calibration curves and the concordance Harrell’s C-indices were used to establish the final model. The validation cohort comprised the patients from the other centers. Results Data from 233 patients were used to construct the nomogram. The validation cohort comprised 36 patients. Independent predictors of overall survival (OS) were identified as HbeAg positive (P = 0.044), blood-type compatibility unmatched (P = 0.034), liver transplantation criteria (P = 0.003), and high MELD score (P = 0.037). For the validation cohort, to predict OS, the C-index of the nomogram was 0.874. Based on the model, patients could be assigned into low-risk (≥ 50%), intermediate-risk (30–50%), and high-risk (≤ 30%) groups to guide adjuvant therapy after surgery and to facilitate personalized management. Conclusions The OS in patients with hepatocellular carcinoma after liver transplantation could be accurately predicted using the developed nomogram.

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The effect of bridging locoregional therapies on survival in hepatocellular carcinoma patients undergoing orthotopic liver transplantation: UNOS population study.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.346 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 346-346 ◽

Cited By ~ 1

Author(s):

Minzhi Xing ◽

Hyun Sik Kim

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Orthotopic Liver Transplantation ◽

Large Scale ◽

Population Based ◽

Meld Score ◽

Kaplan Meier ◽

Comparison Groups ◽

Locoregional Therapies ◽

End Stage

346 Background: The effect of bridging locoregional therapies (LRT) on overall survival (OS) in pts with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) has not been investigated in large-scale population studies. Methods: TheUnited Network for Organ Sharing (UNOS) database was used to identify pts with HCC who received OLT between 2002 and 2010. Pts within Milan Criteria for whom an HCC Model for End-Stage Liver Disease (MELD) exception was approved were included. OS was compared between pts who received bridging LRT (including transarterial chemoembolization (TACE)) and those who did not. Kaplan-Meier estimation and Cox proportional hazard models were used for OS analysis. Results: Of 11,287 pts with HCC who received OLT, 9,876 pts had LRT data, mean age 56.6 yrs, 77% male; 5,103 received bridging LRT, including 3,676 who received TACE. Comparison groups were similar for age at OLT, waitlist duration, sex, race, BMI and MELD score (p>.05 for all). Significantly prolonged OS with bridging LRT vs. none was observed from both OLT (111.6 vs 106.4 mo, p<.001) and from Listing (176.1 vs 169.4 mo, p=.001). Similarly, significantly prolonged OS with bridging TACE vs. none was observed from both OLT (112.0 vs 107.2 mo, p<.001) and from Listing (177.7 vs 169.9 mo, p=.001). Conclusions: In HCC pts undergoing OLT, both bridging LRT and TACE correlated with prolonged survival from OLT and from Listing in a UNOS population-based study. [Table: see text]

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Liver Transplantation for Hepatocellular Carcinoma in the MELD Era: Leading Roles of MELD Score, AFP Level, and Recipient Age as Predictors of Survival

Digestive Diseases and Sciences ◽

10.1007/s10620-008-0680-5 ◽

2009 ◽

Vol 54 (4) ◽

pp. 917-917 ◽

Cited By ~ 8

Author(s):

Georgios C. Sotiropoulos ◽

Ernesto P. Molmenti ◽

Hauke Lang

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Meld Score ◽

Recipient Age

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External validation of the HCC-MELD score for patients with hepatocellular carcinoma waiting for liver transplantation

Digestive and Liver Disease ◽

10.1016/j.dld.2017.01.022 ◽

2017 ◽

Vol 49 (1) ◽

pp. e10

Author(s):

A. Vitale ◽

A.C. Frigo ◽

P. Burra ◽

P. Angeli ◽

G. Zanus ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

External Validation ◽

Meld Score

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Liver Transplantation for T2 Hepatocellular Carcinoma during the COVID-19 Pandemic: A Novel Model Balancing Individual Benefit against Healthcare Resources

Cancers ◽

10.3390/cancers13061416 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1416

Author(s):

Umberto Cillo ◽

Alessandro Vitale ◽

Michael L. Volk ◽

Anna Chiara Frigo ◽

Paolo Feltracco ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Quantitative Model ◽

Meld Score ◽

Waiting List ◽

Ethical Framework ◽

Organ Shortage ◽

Net Benefit ◽

The Individual ◽

End Stage

The COVID-19 pandemic caused temporary drops in the supply of organs for transplantation, leading to renewed debate about whether T2 hepatocellular carcinoma (HCC) patients should receive priority during these times. The aim of this study was to provide a quantitative model to aid decision-making in liver transplantation for T2 HCC. We proposed a novel ethical framework where the individual transplant benefit for a T2 HCC patient should outweigh the harm to others on the waiting list, determining a “net benefit”, to define appropriate organ allocation. This ethical framework was then translated into a quantitative Markov model including Italian averages for waiting list characteristics, donor resources, mortality, and transplant rates obtained from a national prospective database (n = 8567 patients). The net benefit of transplantation in a T2 HCC patient in a usual situation varied from 0 life months with a model for end-stage liver disease (MELD) score of 15, to 34 life months with a MELD score of 40, while it progressively decreased with acute organ shortage during a pandemic (i.e., with a 50% decrease in organs, the net benefit varied from 0 life months with MELD 30, to 12 life months with MELD 40). Our study supports the continuation of transplantation for T2 HCC patients during crises such as COVID-19; however, the focus needs to be on those T2 HCC patients with the highest net survival benefit.

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MELD-Sarcopenia is Better than ALBI and MELD Score in Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation

Asian Pacific Journal of Cancer Prevention ◽

10.31557/apjcp.2021.22.7.2005 ◽

2021 ◽

Vol 22 (7) ◽

pp. 2005-2009

Author(s):

Ayman Alsebaey ◽

Aliaa Sabry ◽

Hanaa Rashed ◽

Maha Elsabaawy ◽

Amr Ragab ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Meld Score ◽

Better Than

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Survival Benefit of Liver Transplantation Versus Resection for Hepatocellular Carcinoma: Impact of MELD Score

Annals of Surgical Oncology ◽

10.1245/s10434-014-4099-2 ◽

2014 ◽

Vol 22 (6) ◽

pp. 1901-1907 ◽

Cited By ~ 24

Author(s):

Alessandro Vitale ◽

Teh-la Huo ◽

Alessandro Cucchetti ◽

Yun-Hsuan Lee ◽

Michael Volk ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Survival Benefit ◽

Meld Score

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Value of HCC-MELD Score in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation

Progress in Transplantation ◽

10.1177/1526924817746686 ◽

2017 ◽

Vol 28 (1) ◽

pp. 63-69 ◽

Cited By ~ 3

Author(s):

Gian Piero Guerrini ◽

Domenico Pinelli ◽

Elena Marini ◽

Vittorio Corno ◽

Michela Guizzetti ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Overall Survival ◽

Cox Regression ◽

Prognostic Score ◽

Disease Free Survival ◽

Meld Score ◽

Poor Overall Survival ◽

Cox Regression Analysis ◽

Improve Risk Stratification

Context: Liver transplantation (LT) is considered the ideal therapy for patients with hepatocellular carcinoma (HCC) having cirrhosis but the shortage of liver donors and the risk of dropout from the wait list due to tumor progression severely limit transplantation. A new prognostic score, the HCC-model for end-stage liver disease (HCC-MELD), was developed by combining α-fetoprotein (AFP), MELD, and tumor size, to improve risk stratification of dropout in patients with HCC. Objectives: In this study, we investigated the ability of the HCC-MELD score in predicting the posttransplant for patients fulfilling Milan criteria (MC). Design: Two hundred patients with stage II tumor were retrospectively reviewed from a total of 1290 transplants performed at our institution from October 1997 through April 2015. Cox regression analysis was performed to identify the prognostic factors impacting the posttransplant survival. Results: Overall survival at 1, 5, and 10 years was 89.3%, 71.1%, and 67.2%, whereas disease-free survival was 86.4%, 66.5%, and 52.4%, respectively. Multivariate analysis showed HCC-MELD score (hazard ratio [HR] 39.6, P < .001) and microvascular invasion (HR 2.41, P = .002) to be independent risk factors for recurrence, whereas HCC diameter (HR 1.15, P = .041), HCC-MELD (HR 15.611, P = .006), and grading (HR 2.17, P = .03) proved to be predictive factors of poor overall survival. Conclusion: Our study showed the validity of the HCC-MELD equation in the evaluation of patients undergoing LT for HCC. This score offers a reliable method to assess the risk of waiting list dropout and predict posttransplantation outcomes.

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A preoperative nomogram predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: A multicenter retrospective study

10.21203/rs.3.rs-32861/v1 ◽

2020 ◽

Author(s):

Dabing Huang ◽

Yinan Shen ◽

Wei Zhang ◽

Chengxiang Guo ◽

Xueli Bai ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Adjuvant Therapy ◽

Validation Cohort ◽

Multivariate Analyses ◽

Meld Score ◽

Blood Type ◽

Intermediate Risk ◽

Final Model ◽

Using Data

Abstract Background Although criteria for liver transplantation, such as the Milan criteria and Hangzhou experiences, have become popular, criteria to guide adjuvant therapy for patients with hepatocellular carcinoma after liver transplantation are lacking. Methods We collected data from all consecutive patients from 2012 to 2019 at three liver transplantation centers in China retrospectively. Univariate and multivariate analyses were used to analyze preoperative parameters, such as demographic and clinical data. Using data obtained in our center, calibration curves and the concordance Harrell’s C-indices were used to establish the final model. The validation cohort comprised the patients from the other centers. Results Data from 233 patients were used to construct the nomogram. The validation cohort comprised 36 patients. Independent predictors of overall survival (OS) were identified as HbeAg positive (P = 0.044), blood-type compatibility unmatched (P = 0.034), liver transplantation criteria (P = 0.003), and high MELD score (P = 0.037). For the validation cohort, to predict OS, the C-index of the nomogram was 0.874. Based on the model, patients could be assigned into low-risk (≥ 50%), intermediate-risk (30–50%), and high-risk (≤ 30%) groups to guide adjuvant therapy after surgery and to facilitate personalized management. Conclusions The OS in patients with hepatocellular carcinoma after liver transplantation could be accurately predicted using the developed nomogram.

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The impact of the model for end-stage liver disease (MELD) on liver transplantation in one center in Brazil

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032010000300004 ◽

2010 ◽

Vol 47 (3) ◽

pp. 233-237 ◽

Cited By ~ 10

Author(s):

Alexandre Coutinho Teixeira de Freitas ◽

William Massami Itikawa ◽

Adriana Sayuri Kurogi ◽

Lucinei G Stadnik ◽

Mônica Beatriz Parolin ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Intensive Care Unit ◽

Liver Transplantation ◽

Intensive Care ◽

Hospital Stay ◽

Red Blood Cells ◽

Blood Cells ◽

Meld Score ◽

Warm Ischemia ◽

Advanced Cirrhosis

CONTEXT: Presently the MELD score is used as the waiting list criterion for liver transplantation in Brazil. In this method more critical patients are considered priority to transplantation. OBJECTIVE: To compare the results of liver transplantation when the chronologic waiting list was the criterion for organ allocation (pre-MELD era) with MELD score period (MELD era) in one liver transplantation unit in Brazil. METHODS: The charts of the patients subjected to liver transplantation at the Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil, were reviewed from January of 2001 to August of 2008. Patients were divided into two groups: pre-MELD era and MELD era. They were compared in relation to demographics of donors and receptors, etiology of cirrhosis, cold and warm ischemia time, presence of hepatocellular carcinoma, MELD score and Child-Pugh score and classification at the time of transplantation, units of red blood cells transfused during the transplantation, intensive care unit stay, total hospital stay and 3 month and 1 year survival. RESULTS: Initially, 205 liver transplantations were analyzed. Ninety four were excluded and 111 were included: 71 on the pre-MELD era and 40 on the MELD era. The two groups were comparable in relation to donors and receptors age and sex, etiology of cirrhosis and cold and warm ischemia time. The receptors of the MELD era had more hepatocellular carcinoma than those of the pre-MELD era (37.5% vs 16.9%). Patients with hepatocellular carcinoma had less advanced cirrhosis on both eras. The MELD score was the same on both eras. Excluding the cases of hepatocellular carcinoma, MELD era score was higher than pre-MELD score (18.2 vs 15.8). There were an increased number of transplants on Child-Pugh A and C and a decreased number on Child-Pugh B receptors on MELD era. Both eras had the same need of red blood cells transfusion, intensive care unit stay and hospital stay. Also, 3 month and 1 year survival were the same: 76% and 74.6% on pre-MELD era and 75% and 70.9% on MELD era. CONCLUSION: In our center, after the introduction of MELD score as the priority criterion for liver transplantation there were an increased number of transplants with hepatocellular carcinoma. Excluding these patients, the receptors were operated upon with more advanced cirrhosis. Nevertheless the patients had the same need for red blood cells transfusion, intensive care unit and hospital stay and 3 months and 1 year survival.

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