Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival

George N Ioannou ¹, James D Perkins , Robert L Carithers

⁰Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA. georgei@medicine.washington.edu

Gastroenterology +

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May 13, 2008

View abstract on PubMed

Summary

The Model for End-Stage Liver Disease (MELD) system increased liver transplants for hepatocellular carcinoma (HCC) sixfold. Patients with large tumors or high MELD scores still face poorer survival post-transplant.

Area Of Science

Hepatology
Transplantation Medicine
Oncology

Background

Early-stage hepatocellular carcinoma (HCC) patients prioritized for liver transplantation in the US since 2002.
The Model for End-Stage Liver Disease (MELD) allocation system implemented in 2002.

Purpose Of The Study

To evaluate the impact of the MELD allocation system on liver transplantation rates for HCC.
To assess post-transplantation survival outcomes for HCC patients under the MELD system.

Main Methods

Analysis of 19,404 liver transplants (2002-2007) and 15,906 (1997-2002) from the United Network for Organ Sharing.
Comparison of HCC prevalence and survival rates before and after MELD implementation.

Main Results

HCC prevalence among liver transplant recipients increased from 4.6% (1997-2002) to 26% (2002-2007).
Patients with "HCC-MELD-exceptions" showed similar survival to non-HCC patients, but those with 3-5 cm tumors had worse outcomes.
High MELD scores (≥20) and elevated alpha-fetoprotein (≥455 ng/mL) were linked to poorer post-transplant survival.

Conclusions

The MELD system significantly increased liver transplantation for HCC patients.
Tumor size (3-5 cm), high alpha-fetoprotein, and high MELD scores predict poor post-transplant survival in HCC patients.

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