A Second Look at the OPTN Explant Pathology Form Data.

Abstract

Background: Candidates with exceptions for hepatocellular carcinoma (HCC) accounted for approximately 30% of liver transplants in 2012. OPTN policy requires submission of the post-transplant pathology form to confirm diagnosis of HCC for recipients with exceptions. The OPTN, as part of its ongoing monitoring activity, has been evaluating these data since an on-line form was created in 2012. Methods: Pathology forms submitted between 4/12/2012 and 9/30/2013 were included. Results: Of the 2516 forms submitted, 90.7% indicated loco-regional treatment (LRT) for HCC and 91.7% showed evidence of HCC. The level of tumor differentiation was reported as well, moderate, or poor in 26.0%, 48.8%, and 7.8%, with complete tumor necrosis in 17.4%. Most (84.2%) showed no vascular invasion, with 13.9% indicating microvascular and 1.9% with macrovascular invasion. Very few indicated lymph node involvement (1.9%) or extrahepatic spread (0.8%) and 7.2% reported satellite lesions. Just over half were Stage T2 on imaging, with those listed with a T2 exception at 56%.Figure: No Caption available.A subset of 1192 recipients transplanted in 2012 were followed to identify recurrence using the post-transplant malignancy form, or a cause of death (COD) indicating recurrent disease. Recurrence was identified in 34 patients (2.9%). Those with poor tumor differentiation or micro/macro vascular invasion were more likely to have recurrence, at 8.6%, 7.1%, and 5.0%. The median time to recurrence was 255 days. Discussion: Most patients with an HCC exception demonstrated tumor within the explant, and 71.3% of those with tumor information were Stage T1 or T2. The great majority of patients receive LRT. Preliminarily, there appears to be a subset of patients who are more likely to have recurrence. These data, when combined with newly-available pre-transplant imaging data, may help to refine future policies for HCC exceptions as more follow-up data accrue.