Resection vs Transplant Listing for Hepatocellular Carcinoma: An Intention-to-Treat Analysis

Guy Meyerovich, Yaacov Goykhman, Richard Nakache, Ido Nachmany, Guy Lahat, Oren Shibolet, Y. Menachem, Helena Katchman, Ido Wolf, R. Geva, Joseph M. Klausner, Nir Lubezky

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Liver transplantation (LT) and liver resection (LR) are curative treatment options for patients with hepatocellular carcinoma within the Milan criteria. Severe organ shortage dictates the preference for LR. Our aim was to provide an intention-to-treat retrospective comparison of survival between patients who were placed on waiting lists for LT and those who underwent LR. Methods: The medical records of patients with hepatocellular carcinoma within the Milan criteria treated by LR or listed for LT between 2007 and 2016 were reviewed. We performed intention-to-treat analyses of overall survival and recurrence. Results: There were 54 patients on the waiting list for LT, and 30 of them underwent LR. Thirteen of the 54 patients (24%) were not transplanted because of disease-related mortality or tumor progression. The median waiting time to transplantation was 304 days. The 90-day mortality was higher in transplanted patients (9.8% vs 3.3%, P = .003). Intention-to-treat survival was similar for the LT and LR groups (5-year survival, 47.8% vs 55%, respectively, P = .185). There was a trend toward improved 5-year disease-free survival for listed patients (56.2% vs 26.3% for patients undergoing LR, P = .15). Conclusion: Intention-to-treat survival is similar in patients undergoing LR and those on waiting lists for LT. There is a 24% risk to drop from the transplant list.

Original languageEnglish
Pages (from-to)1867-1873
Number of pages7
JournalTransplantation Proceedings
Volume51
Issue number6
DOIs
StatePublished - 1 Jul 2019
Externally publishedYes

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