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Impact of model for end-stage liver disease on patient survival and disease-free survival in patients receiving liver transplantation for hepatocellular carcinoma.

Abstract

We combined data from two transplant centers to determine the impact of the model for end-stage liver disease (MELD) allocation system on outcomes in patients undergoing liver transplantation for hepatocellular carcinoma (HCC). We compared 55 patients listed before MELD to 117 patients in the MELD era. Patients before MELD were less likely to receive a transplant (67% vs 91%) and waited a median of 127 days vs 20 days (P < .001). On an intention to treat (ITT) basis, the 1-, 3-, and 5-year survivals for patients before MELD were 79%, 60%, and 48%, and in the MELD era were 84%, 73%, and 73% (P = .055). On an ITT basis, the 1-, 3-, and 5-year tumor-free survivals before MELD were 58%, 58%, and 55% vs 83%, 74%, and 70% in the MELD era (P = .018). In patients who received a transplant, however, there were no differences in overall or tumor-free survival. In these patients, the 1-, 3-, and 5-year patient survivals were 92%, 84%, and 67% before MELD, and 90%, 81%, and 81% in the MELD era (P = .57). In transplanted patients, the 1-, 3-, and 5-year tumor-free survivals before MELD were 88%, 88%, and 83% vs 92%, 83%, and 78% in the MELD era (P = .403). On explant, patients listed before MELD had lower grade tumors (P = .046). We concluded that patients with HCC listed in the MELD era had higher and more rapid rates of transplantation with improvements in survival. However, the more efficacious rates of transplantation did not result in lower rates of tumor recurrence.

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  • Authors+Show Affiliations

    ,

    Division of Gastroenterology, Henry Ford Health System, Detroit, Michigan 48322, USA. dmoonkal@hfhs.org

    , , , ,

    Source

    MeSH

    Adult
    Carcinoma, Hepatocellular
    Cohort Studies
    Disease-Free Survival
    Female
    Humans
    Liver Failure
    Liver Neoplasms
    Liver Transplantation
    Male
    Middle Aged
    Survival Analysis

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    19249517

    Citation

    Moonka, D, et al. "Impact of Model for End-stage Liver Disease On Patient Survival and Disease-free Survival in Patients Receiving Liver Transplantation for Hepatocellular Carcinoma." Transplantation Proceedings, vol. 41, no. 1, 2009, pp. 216-8.
    Moonka D, Castillo E, Kumer S, et al. Impact of model for end-stage liver disease on patient survival and disease-free survival in patients receiving liver transplantation for hepatocellular carcinoma. Transplant Proc. 2009;41(1):216-8.
    Moonka, D., Castillo, E., Kumer, S., Abouljoud, M., Divine, G., & Pelletier, S. (2009). Impact of model for end-stage liver disease on patient survival and disease-free survival in patients receiving liver transplantation for hepatocellular carcinoma. Transplantation Proceedings, 41(1), pp. 216-8. doi:10.1016/j.transproceed.2008.09.060.
    Moonka D, et al. Impact of Model for End-stage Liver Disease On Patient Survival and Disease-free Survival in Patients Receiving Liver Transplantation for Hepatocellular Carcinoma. Transplant Proc. 2009;41(1):216-8. PubMed PMID: 19249517.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Impact of model for end-stage liver disease on patient survival and disease-free survival in patients receiving liver transplantation for hepatocellular carcinoma. AU - Moonka,D, AU - Castillo,E, AU - Kumer,S, AU - Abouljoud,M, AU - Divine,G, AU - Pelletier,S, PY - 2008/08/13/received PY - 2008/09/18/accepted PY - 2009/3/3/entrez PY - 2009/3/3/pubmed PY - 2009/4/28/medline SP - 216 EP - 8 JF - Transplantation proceedings JO - Transplant. Proc. VL - 41 IS - 1 N2 - We combined data from two transplant centers to determine the impact of the model for end-stage liver disease (MELD) allocation system on outcomes in patients undergoing liver transplantation for hepatocellular carcinoma (HCC). We compared 55 patients listed before MELD to 117 patients in the MELD era. Patients before MELD were less likely to receive a transplant (67% vs 91%) and waited a median of 127 days vs 20 days (P < .001). On an intention to treat (ITT) basis, the 1-, 3-, and 5-year survivals for patients before MELD were 79%, 60%, and 48%, and in the MELD era were 84%, 73%, and 73% (P = .055). On an ITT basis, the 1-, 3-, and 5-year tumor-free survivals before MELD were 58%, 58%, and 55% vs 83%, 74%, and 70% in the MELD era (P = .018). In patients who received a transplant, however, there were no differences in overall or tumor-free survival. In these patients, the 1-, 3-, and 5-year patient survivals were 92%, 84%, and 67% before MELD, and 90%, 81%, and 81% in the MELD era (P = .57). In transplanted patients, the 1-, 3-, and 5-year tumor-free survivals before MELD were 88%, 88%, and 83% vs 92%, 83%, and 78% in the MELD era (P = .403). On explant, patients listed before MELD had lower grade tumors (P = .046). We concluded that patients with HCC listed in the MELD era had higher and more rapid rates of transplantation with improvements in survival. However, the more efficacious rates of transplantation did not result in lower rates of tumor recurrence. SN - 0041-1345 UR - https://www.unboundmedicine.com/medline/citation/19249517/Impact_of_model_for_end_stage_liver_disease_on_patient_survival_and_disease_free_survival_in_patients_receiving_liver_transplantation_for_hepatocellular_carcinoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(08)01559-5 DB - PRIME DP - Unbound Medicine ER -