Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria: a single center experience

Research output: Contribution to journalArticle

David W Victor, Howard P Monsour, Maha Boktour, Keri Lunsford, Julius Balogh, Edward A Graviss, Duc T Nguyen, Robert McFadden, Mukul K Divatia, Kirk Heyne, Victor Ankoma-Sey, Chukwuma Egwim, Joseph Galati, Andrea Duchini, Ashish Saharia, Constance Mobley, A Osama Gaber, R Mark Ghobrial

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. Currently, liver transplantation may be the optimal treatment for HCC in cirrhotic patients. Patient selection is currently based on tumor size. We developed a program to offer liver transplantation to selected patients with HCC outside of traditional criteria.

METHODS: Retrospective review for patients transplanted with HCC between April 2008 and June 2017. Patients were grouped by tumor size according to Milan, UCSF, and outside UCSF criteria. Patient demographics, laboratory values, and outcomes were compared. Patients radiographically outside Milan criteria were selected based on tumor control with locoregional therapy (LRT) and 9 months of stability from LRT. Alpha-fetoprotein values were not exclusionary.

RESULTS: 220 HCC patients were transplanted, 138 inside Milan, 23 inside UCSF, and 59 beyond UCSF criteria. Patient survival was equivalent at 1, 3 or 5 year despite pathologic tumor size. Waiting time to transplantation was not significantly different at an average of 344 days. In patients outside UCSF, tumor recurrence was equivalent to Milan and UCSF criteria recipients who waited greater than 9 months from LRT. Although tumor recurrence was more likely in outside of UCSF patients (3% vs. 9% vs. 15% p=0.02), recurrence free survival only trended toward significance amongst the groups (p=0.053).

CONCLUSION: Selective patients outside of traditional size criteria can be effectively transplanted with equivalent survival to patients with smaller tumors, even when pathologic tumor burden is considered. Tumor stability over time can be used to help select patients for transplantation.

Original languageEnglish (US)
JournalTransplantation
DOIs
StateE-pub ahead of print - Jun 18 2019

PMID: 31233480

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Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria : a single center experience. / Victor, David W; Monsour, Howard P; Boktour, Maha; Lunsford, Keri; Balogh, Julius; Graviss, Edward A; Nguyen, Duc T; McFadden, Robert; Divatia, Mukul K; Heyne, Kirk; Ankoma-Sey, Victor; Egwim, Chukwuma; Galati, Joseph; Duchini, Andrea; Saharia, Ashish; Mobley, Constance; Gaber, A Osama; Ghobrial, R Mark.

In: Transplantation, 18.06.2019.

Research output: Contribution to journalArticle

Harvard

Victor, DW, Monsour, HP, Boktour, M, Lunsford, K, Balogh, J, Graviss, EA, Nguyen, DT, McFadden, R, Divatia, MK, Heyne, K, Ankoma-Sey, V, Egwim, C, Galati, J, Duchini, A, Saharia, A, Mobley, C, Gaber, AO & Ghobrial, RM 2019, 'Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria: a single center experience' Transplantation. https://doi.org/10.1097/TP.0000000000002835

APA

Victor, D. W., Monsour, H. P., Boktour, M., Lunsford, K., Balogh, J., Graviss, E. A., ... Ghobrial, R. M. (2019). Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria: a single center experience. Transplantation. https://doi.org/10.1097/TP.0000000000002835

Vancouver

Victor DW, Monsour HP, Boktour M, Lunsford K, Balogh J, Graviss EA et al. Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria: a single center experience. Transplantation. 2019 Jun 18. https://doi.org/10.1097/TP.0000000000002835

Author

Victor, David W ; Monsour, Howard P ; Boktour, Maha ; Lunsford, Keri ; Balogh, Julius ; Graviss, Edward A ; Nguyen, Duc T ; McFadden, Robert ; Divatia, Mukul K ; Heyne, Kirk ; Ankoma-Sey, Victor ; Egwim, Chukwuma ; Galati, Joseph ; Duchini, Andrea ; Saharia, Ashish ; Mobley, Constance ; Gaber, A Osama ; Ghobrial, R Mark. / Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria : a single center experience. In: Transplantation. 2019.

BibTeX

@article{d4200462a7744fb3910fdc7182ed0dec,
title = "Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria: a single center experience",
abstract = "BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. Currently, liver transplantation may be the optimal treatment for HCC in cirrhotic patients. Patient selection is currently based on tumor size. We developed a program to offer liver transplantation to selected patients with HCC outside of traditional criteria.METHODS: Retrospective review for patients transplanted with HCC between April 2008 and June 2017. Patients were grouped by tumor size according to Milan, UCSF, and outside UCSF criteria. Patient demographics, laboratory values, and outcomes were compared. Patients radiographically outside Milan criteria were selected based on tumor control with locoregional therapy (LRT) and 9 months of stability from LRT. Alpha-fetoprotein values were not exclusionary.RESULTS: 220 HCC patients were transplanted, 138 inside Milan, 23 inside UCSF, and 59 beyond UCSF criteria. Patient survival was equivalent at 1, 3 or 5 year despite pathologic tumor size. Waiting time to transplantation was not significantly different at an average of 344 days. In patients outside UCSF, tumor recurrence was equivalent to Milan and UCSF criteria recipients who waited greater than 9 months from LRT. Although tumor recurrence was more likely in outside of UCSF patients (3{\%} vs. 9{\%} vs. 15{\%} p=0.02), recurrence free survival only trended toward significance amongst the groups (p=0.053).CONCLUSION: Selective patients outside of traditional size criteria can be effectively transplanted with equivalent survival to patients with smaller tumors, even when pathologic tumor burden is considered. Tumor stability over time can be used to help select patients for transplantation.",
author = "Victor, {David W} and Monsour, {Howard P} and Maha Boktour and Keri Lunsford and Julius Balogh and Graviss, {Edward A} and Nguyen, {Duc T} and Robert McFadden and Divatia, {Mukul K} and Kirk Heyne and Victor Ankoma-Sey and Chukwuma Egwim and Joseph Galati and Andrea Duchini and Ashish Saharia and Constance Mobley and Gaber, {A Osama} and Ghobrial, {R Mark}",
year = "2019",
month = "6",
day = "18",
doi = "10.1097/TP.0000000000002835",
language = "English (US)",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",

}

RIS

TY - JOUR

T1 - Outcomes of Liver transplantation for hepatocellular carcinoma (HCC) beyond the University of California San Francisco (UCSF) criteria

T2 - Transplantation

AU - Victor, David W

AU - Monsour, Howard P

AU - Boktour, Maha

AU - Lunsford, Keri

AU - Balogh, Julius

AU - Graviss, Edward A

AU - Nguyen, Duc T

AU - McFadden, Robert

AU - Divatia, Mukul K

AU - Heyne, Kirk

AU - Ankoma-Sey, Victor

AU - Egwim, Chukwuma

AU - Galati, Joseph

AU - Duchini, Andrea

AU - Saharia, Ashish

AU - Mobley, Constance

AU - Gaber, A Osama

AU - Ghobrial, R Mark

PY - 2019/6/18

Y1 - 2019/6/18

N2 - BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. Currently, liver transplantation may be the optimal treatment for HCC in cirrhotic patients. Patient selection is currently based on tumor size. We developed a program to offer liver transplantation to selected patients with HCC outside of traditional criteria.METHODS: Retrospective review for patients transplanted with HCC between April 2008 and June 2017. Patients were grouped by tumor size according to Milan, UCSF, and outside UCSF criteria. Patient demographics, laboratory values, and outcomes were compared. Patients radiographically outside Milan criteria were selected based on tumor control with locoregional therapy (LRT) and 9 months of stability from LRT. Alpha-fetoprotein values were not exclusionary.RESULTS: 220 HCC patients were transplanted, 138 inside Milan, 23 inside UCSF, and 59 beyond UCSF criteria. Patient survival was equivalent at 1, 3 or 5 year despite pathologic tumor size. Waiting time to transplantation was not significantly different at an average of 344 days. In patients outside UCSF, tumor recurrence was equivalent to Milan and UCSF criteria recipients who waited greater than 9 months from LRT. Although tumor recurrence was more likely in outside of UCSF patients (3% vs. 9% vs. 15% p=0.02), recurrence free survival only trended toward significance amongst the groups (p=0.053).CONCLUSION: Selective patients outside of traditional size criteria can be effectively transplanted with equivalent survival to patients with smaller tumors, even when pathologic tumor burden is considered. Tumor stability over time can be used to help select patients for transplantation.

AB - BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. Currently, liver transplantation may be the optimal treatment for HCC in cirrhotic patients. Patient selection is currently based on tumor size. We developed a program to offer liver transplantation to selected patients with HCC outside of traditional criteria.METHODS: Retrospective review for patients transplanted with HCC between April 2008 and June 2017. Patients were grouped by tumor size according to Milan, UCSF, and outside UCSF criteria. Patient demographics, laboratory values, and outcomes were compared. Patients radiographically outside Milan criteria were selected based on tumor control with locoregional therapy (LRT) and 9 months of stability from LRT. Alpha-fetoprotein values were not exclusionary.RESULTS: 220 HCC patients were transplanted, 138 inside Milan, 23 inside UCSF, and 59 beyond UCSF criteria. Patient survival was equivalent at 1, 3 or 5 year despite pathologic tumor size. Waiting time to transplantation was not significantly different at an average of 344 days. In patients outside UCSF, tumor recurrence was equivalent to Milan and UCSF criteria recipients who waited greater than 9 months from LRT. Although tumor recurrence was more likely in outside of UCSF patients (3% vs. 9% vs. 15% p=0.02), recurrence free survival only trended toward significance amongst the groups (p=0.053).CONCLUSION: Selective patients outside of traditional size criteria can be effectively transplanted with equivalent survival to patients with smaller tumors, even when pathologic tumor burden is considered. Tumor stability over time can be used to help select patients for transplantation.

U2 - 10.1097/TP.0000000000002835

DO - 10.1097/TP.0000000000002835

M3 - Article

JO - Transplantation

JF - Transplantation

SN - 0041-1337

ER -

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