Liver transplant assessment for hepatocellular carcinoma: a single-centre experience

The incidence of hepatocellular carcinoma (HCC) continues to rise dramatically in the UK. Liver transplantation offers a potential cure and there is a large body of evidence demonstrating good outcomes. However, there is a paucity of data on the assessment, acceptance rates, and reasons for turning down liver transplantation in HCC.

We undertook an analysis of all patients with HCC referred for liver transplant assessment to a tertiary liver centre between January 2015 and January 2020. Patient and tumour demographics, assessment outcomes and overall survival were analysed. Multivariate analysis was performed on factors affecting listing decisions. To evaluate the impact of the COVID-19 pandemic, data collection was extended from March 2020 to March 2021.

Of 263 patients with HCC who completed liver transplant assessment, 168 (64%) were accepted for listing. The most common factors associated with a decision not to list a patient were medical comorbidities (n=50, 56.2% of those not listed) and rapid tumour progression (n=25, 26.3%). Of patients who were listed, 145 (86.4%) received a liver transplant. Five year survival from the time of transplant assessment was 68% with transplant and 12% without.The pandemic resulted in more patients progressing out of criteria after listing. Prepandemic median dropout per annum was 2% (0%-9%), compared with 25% during the pandemic study period.

This study provides outcomes on patients with HCC referred for transplant assessment, identifying factors for non-listing and confirming the negative impact of decreased transplant activity during the pandemic on waiting list dropouts for HCC patients.