Patients with end-stage liver disease complicated by the most common type of liver cancer — hepatocellular carcinoma (HCC) — are less likely to die or become too sick for a transplant while waiting for a new liver than those with other complications of end-stage liver disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The investigators say their findings should prompt a re-examination of the criteria used to prioritize liver transplant candidates. Only three percent of patients with this common form of cancer who had been on the wait list for six to nine months were removed within 90 days because of death or advanced illness, compared to 24 percent of non-HCC candidates who were considered to be at the same level of need for transplant. The results of the study are published in the April issue of Liver Transplantation.
"With the scarcity of available livers for transplantation, it is imperative that the prioritization criteria ensure that the candidates who are at the greatest risk of dying from the disease be the first ones to receive a life-saving organ," said lead author David Goldberg, MD, an instructor in the department of Gastroenterology. "Our study compared the morality risk for patients with HCC to those with similar scores, but without liver cancer. What we found is that ultimately, the process used to determine transplant priority is making it so that these HCC patients are receiving healthy livers first, when in actuality, they are less likely to die while waiting for a new organ. This is an issue of utmost importance, because nearly 2,000 patients die each year waiting for a new liver on the transplant waitlist, while 25 to 30 percent of transplants are performed in patients with HCC."
Currently, transplant candidates are placed on the waitlist in an order determined by the results of a scoring system which determines how urgently they will need a liver transplant within the next three months. Patients with a higher score are placed higher on the waitlist. Because candidates with HCC have an increased risk of dropping off of the wait list due to progression of their tumor, they are given additional points when initially wait-listed, and receive more points the longer they remain on the waitlist. As their scores climb, it becomes more likely that these patients will receive transplants before other patients who may, according to the new study, actually be at greater risk of dying.
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