UNOS DonateLife

May 25, 2005

Does Clinical or Histologic Stage Make a Difference in Outcome for Patients with HCC Receiving Liver

Authors: Ann M. Harper*, Erick B. Edwards, Ph.D.*, Abigail Mithoefer, P.A., Anthony Schore, M.D., Richard B. Freeman, M.D.

Seattle, Wash. -- The Model for End-Stage Liver Disease (MELD) is a numerical scale currently used for liver allocation. MELD scores are based on a patient's risk of dying while waiting for a liver transplant, and are based on objective and verifiable medical data. A study examined the results of liver transplantation for hepatocellular carcinoma (HCC) under the MELD system. This study, among others, was presented at the American Transplant Congress, a combined scientific session of the American Society of Transplant Surgeons and the American Society of Transplantation, held at the Washington State Convention and Trade Center in Seattle, Wash. United Network for Organ Sharing staff researchers are indicated with an asterisk.

This study analyzed 2074 candidates transplanted with HCC exceptions between February 27, 2002 and December 31, 2004 for which complete listing, explant histology and follow-up data were available.

Analyses revealed that liver recipients with a histologic stage of 4b have a very poor prognosis and that clinical staging does not appear to identify these patients. Since vascular invasion is the unique feature of stage 4b HCC, increased efforts to detect this are recommended. The study also concluded that pre-transplant staging is not predictive of the pathologic stage, and that ablative therapies have no apparent impact on post-transplant survival.

A private, nonprofit organization, UNOS manages the nation's organ transplant system and oversees the world's most comprehensive database of clinical transplant information under contract with the federal government. UNOS operates the 24-hour computerized organ sharing system, matching donated organs to patients registered on the national organ transplant waiting list. UNOS seeks to increase organ donation through education and improve transplant success rates through outcomes-based research and policymaking. The strength of the transplant database relies on the conscientious reporting of 412 UNOS member institutions.