Downstaging Hepatocellular Carcinoma before Liver Transplantation: A Multicenter Analysis of the "All-Comers" Protocol in the MERITS-LT Consortium.

Abstract

Patients with HCC meeting UNOS-downstaging (DS) criteria have excellent liver transplant (LT) outcomes after downstaging. However, outcomes for "all-comers" (AC) patients with tumors initially exceeding UNOS-DS are poorly understood. Patients meeting AC (n=82) or UNOS-DS (n=229) at 7 LT centers in 4 UNOS regions were prospectively followed from 2015-2020. AC patients had a lower probability of successful DS (67% vs 83% within 12 months;p<0.001). 3-year-survival was 69% for UNOS-DS vs. 58% for AC (p=0.05) and reduced to 30% in patients with Child-Pugh B/C cirrhosis or AFP >500. Five-year LT probability was 42% for AC vs. 74% in UNOS-DS (p=0.10). Thirty-eight percent were under-staged on explant with increasing sum of largest tumor diameter plus number of lesions prior to LT (OR 1.3;p=0.01) and AFP>20 (OR 5.9;p=0.005) associated with understaging. Post-LT 3-year survival was 91% for AC vs 81% for UNOS-DS (p=0.67). In this first prospective multi-regional study of AC patients from the MERITS-LT Consortium, we observed a 65% probability of successful downstaging. Three-year survival in AC was nearly 60% though AC with Child-Pugh B/C or AFP >500 had poor survival. Explant pathology and 3-year post-LT outcomes were similar between cohorts suggesting that LT is a reasonable goal in selected AC patients.

View details for DOI 10.1016/j.ajt.2023.07.021

View details for PubMedID 37532179