Tags

Type your tag names separated by a space and hit enter

A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy.
Liver Transpl. 2003 Jul; 9(7):684-92.LT

Abstract

Since our interim report of the intention-to-treat outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), we have performed a follow-up analysis of an expanded cohort of 70 patients to further assess whether the observed pattern and predictors of dropout are consistent with the rationale behind current HCC-adjusted Model for End Stage Liver Disease (MELD) organ allocation scheme. All except one patient had pretransplantation staging meeting our proposed expanded criteria-a single lesion < or =6.5 cm, or three or fewer lesions none >4.5 cm and total tumor diameter < or =8 cm. Thirty-eight patients received OLT. The cumulative probabilities of dropout at 6, 12, and 18 months were 7.2%, 37.8%, and 55.1%, respectively. The respective dropout probabilities would have been 11.0%, 57.4%, and 68.7% if the United Network for Organ Sharing (UNOS) criteria for exclusion (single lesion < or =5 cm or three or fewer lesions none >3 cm) were applied. Predictors of dropout with either criteria included three tumor nodules and a single lesion >3 cm at initial presentation, whereas preoperative chemoembolization or ablation therapies were associated with a lower risk for dropout only when applying the UNOS criteria for patient exclusion. In the subgroup with two or three lesions or a solitary tumor >3 cm, the cumulative probabilities of dropout were nine-fold higher than those with a single lesion < or =3 cm (P =.004). In conclusion, the low dropout rate in the first 6 months and the differing dropout risks based on tumor characteristics support further refinements in the HCC-adjusted MELD organ allocation scheme.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology, University of California, San Francisco 94143, USA. yaofyk@itsa.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12827553

Citation

Yao, Francis Y., et al. "A Follow-up Analysis of the Pattern and Predictors of Dropout From the Waiting List for Liver Transplantation in Patients With Hepatocellular Carcinoma: Implications for the Current Organ Allocation Policy." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 9, no. 7, 2003, pp. 684-92.
Yao FY, Bass NM, Nikolai B, et al. A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transpl. 2003;9(7):684-92.
Yao, F. Y., Bass, N. M., Nikolai, B., Merriman, R., Davern, T. J., Kerlan, R., Ascher, N. L., & Roberts, J. P. (2003). A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 9(7), 684-92.
Yao FY, et al. A Follow-up Analysis of the Pattern and Predictors of Dropout From the Waiting List for Liver Transplantation in Patients With Hepatocellular Carcinoma: Implications for the Current Organ Allocation Policy. Liver Transpl. 2003;9(7):684-92. PubMed PMID: 12827553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: implications for the current organ allocation policy. AU - Yao,Francis Y, AU - Bass,Nathan M, AU - Nikolai,Bev, AU - Merriman,Raphael, AU - Davern,Timothy J, AU - Kerlan,Robert, AU - Ascher,Nancy L, AU - Roberts,John P, PY - 2003/6/27/pubmed PY - 2003/9/17/medline PY - 2003/6/27/entrez SP - 684 EP - 92 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 9 IS - 7 N2 - Since our interim report of the intention-to-treat outcome of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), we have performed a follow-up analysis of an expanded cohort of 70 patients to further assess whether the observed pattern and predictors of dropout are consistent with the rationale behind current HCC-adjusted Model for End Stage Liver Disease (MELD) organ allocation scheme. All except one patient had pretransplantation staging meeting our proposed expanded criteria-a single lesion < or =6.5 cm, or three or fewer lesions none >4.5 cm and total tumor diameter < or =8 cm. Thirty-eight patients received OLT. The cumulative probabilities of dropout at 6, 12, and 18 months were 7.2%, 37.8%, and 55.1%, respectively. The respective dropout probabilities would have been 11.0%, 57.4%, and 68.7% if the United Network for Organ Sharing (UNOS) criteria for exclusion (single lesion < or =5 cm or three or fewer lesions none >3 cm) were applied. Predictors of dropout with either criteria included three tumor nodules and a single lesion >3 cm at initial presentation, whereas preoperative chemoembolization or ablation therapies were associated with a lower risk for dropout only when applying the UNOS criteria for patient exclusion. In the subgroup with two or three lesions or a solitary tumor >3 cm, the cumulative probabilities of dropout were nine-fold higher than those with a single lesion < or =3 cm (P =.004). In conclusion, the low dropout rate in the first 6 months and the differing dropout risks based on tumor characteristics support further refinements in the HCC-adjusted MELD organ allocation scheme. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/12827553/A_follow_up_analysis_of_the_pattern_and_predictors_of_dropout_from_the_waiting_list_for_liver_transplantation_in_patients_with_hepatocellular_carcinoma:_implications_for_the_current_organ_allocation_policy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1527646503003113 DB - PRIME DP - Unbound Medicine ER -