Click here for the next report.

San Francisco—Results of a multicenter trial suggest a transplantation timing sweet spot before and after which hepatocellular carcinoma (HCC) is likely to recur. Neither very short waits nor very long waits before transplantation are optimal. N Mehta and his team have concluded that >6 months and <18 months is the optimal period within which to perform transplantation following diagnosis of HCC.

Mehta, et al, further suggested that short waits may transplant aggressive tumors that can cause post-transplant recurrence. Long waits, on the other hand, for patients with HCC, may enable a shift to more aggressive tumor behavior. The team presented poster 50 at the 2015 annual meeting of the AASLD, held here recently. You can access the entire abstract here.

In a multivariate analysis that considered only pre-liver transplant factors, a wait time of <6 months or >18 months, and alpha-fetoprotein levels greater than 400 ng/mL at HCC diagnosis most strongly predicted HCC recurrence.

Just under a third of patients (32.4%) waited <6 months from diagnosis of HCC to transplantation, 53.7% waited 6 to 18 months, and 13.9% waited >18 months. The drop-out rate was 18.4% at a median of 11.6 months, with the majority dropouts (85.1%) coming from the center with the longest wait times.

Median follow-up was 4.2 years after transplantation. Kaplan Meier 1- and 5-year post-liver transplant survival rates were 92.8% and 77.4%, respectively. For patients with wait times of <6 months or >18 months (343), the cumulative probabilities of HCC recurrence were 6.4% at 1 year and 15.5% at 5 years. For those who waited 6 to 18 months (397), the probability of HCC recurrence were about a third lower; 4.5% at 1 year and 9.8% at 5 years.