Hepatocellular Carcinoma Transplant Criteria Show Poor Negative Predictive Value: A Systematic Review and...

Area of Science:

• Hepatobiliary Surgery
• Transplant Immunology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) patient selection for liver transplantation (LT) relies on multiple global criteria.
• Accurate identification of HCC patients at high risk of recurrence post-LT remains a challenge for stakeholders.
• Existing criteria's efficacy in identifying high-risk HCC patients for LT needs critical evaluation.

Purpose of the Study:

• To identify the most accurate criteria for selecting hepatocellular carcinoma (HCC) patients eligible for liver transplantation (LT).
• To evaluate the diagnostic performance of current LT selection criteria for HCC patients.
• To address ethical concerns regarding the exclusion of potential LT candidates based on current criteria.

Main Methods:

• Systematic literature search in PubMed and CENTRAL databases (June 2023).
• Data extraction from recurrence-free survival curves using a validated algorithm.
• Calculation of diagnostic performance measures, adhering to PRISMA guidelines.

Main Results:

• Seventeen studies met inclusion criteria, evaluating 14 distinct LT selection criteria for HCC.
• All criteria demonstrated high adjusted positive predictive values (>80%) for selecting low-risk HCC patients.
• Most criteria showed low adjusted negative predictive values (<50%), failing to accurately identify high-risk HCC patients for LT.

Conclusions:

• Current LT selection criteria for HCC patients exhibit limitations in accurately identifying high-risk individuals.
• There is an urgent need for refined or novel criteria with improved specificity and negative predictive value.
• Enhanced criteria could enable the selection of more suitable LT candidates currently excluded.