Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation

Sophia Schmitz; Georg Lurje; Florian Ulmer; Anne Andert; Philipp Bruners; Maximilian Schulze-Hagen; Ulf Neumann; Wenzel Schoening

doi:10.1016/j.hbpd.2019.01.004

Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation

Hepatobiliary Pancreat Dis Int. 2019 Jun;18(3):228-236. doi: 10.1016/j.hbpd.2019.01.004. Epub 2019 Jan 21.

Authors

Sophia Schmitz¹, Georg Lurje¹, Florian Ulmer¹, Anne Andert¹, Philipp Bruners², Maximilian Schulze-Hagen², Ulf Neumann³, Wenzel Schoening⁴

Affiliations

¹ Department of General-, Visceral- and Transplantation Surgery, University Hospital of RWTH Aachen, Aachen, Germany.
² Department of Diagnostic and Interventional Radiology, University Hospital of RWTH Aachen, Aachen, Germany.
³ Department of General-, Visceral- and Transplantation Surgery, University Hospital of RWTH Aachen, Aachen, Germany; Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands.
⁴ Department of General-, Visceral- and Transplantation Surgery, University Hospital of RWTH Aachen, Aachen, Germany; Department of Surgery, Charité - University Medicine at Berlin, Germany. Electronic address: wenzel.schoening@charite.de.

PMID: 30718181
DOI: 10.1016/j.hbpd.2019.01.004

Abstract

Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, "extended critera donor (ECD) organs" are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary.

Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses.

Results: One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P = 0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P = 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P = 0.663).

Conclusions: Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option.

Keywords: Hepatocellular carcinoma; Liver neoplasms; Liver transplantation; Organ transplantation; Therapeutic embolization.

MeSH terms

Aged
Carcinoma, Hepatocellular / diagnostic imaging
Carcinoma, Hepatocellular / mortality
Carcinoma, Hepatocellular / secondary
Carcinoma, Hepatocellular / therapy*
Disease-Free Survival
Female
Humans
Liver Neoplasms / diagnostic imaging
Liver Neoplasms / mortality
Liver Neoplasms / pathology
Liver Neoplasms / therapy*
Liver Transplantation* / adverse effects
Liver Transplantation* / mortality
Male
Middle Aged
Neoadjuvant Therapy* / adverse effects
Neoadjuvant Therapy* / mortality
Patient Dropouts
Retrospective Studies
Risk Factors
Time Factors
Time-to-Treatment*
Tissue Donors / supply & distribution*
Waiting Lists* / mortality