Impact of “Time to Transplant” On Recurrence of Hepatocellular Carcinoma (HCC).

Abstract

Background: Recurrence rates of HCC post LT vary and predictors of recurrence are being defined. Transplant too soon after diagnosis may not allow time for “tumor biology” to express itself, resulting in a higher risk of tumor recurrence. The purpose of this study is to evaluate known factors associated with the recurrence of HCC post transplant and evaluate the importance of time to transplant on HCC recurrence. Methodology: This study is a retrospective analysis of patients with HCC in a national integrated care delivery system, who had LT from January 2002 - December 2009. The patients were dispersed across 5 states and 8 different liver transplant programs. They were followed from time of diagnosis for at least 4 years post transplant or until death or retransplant. Variables that could impact the incidence of HCC recurrence were evaluated. Data was extracted from Kaiser Permanente's National Transplant Services patient registry and EMR, KPHealthConnect®. MELD at transplant and transplant pathology was obtained from the transplant centers to compare with patient records to validate data. Summary of Results: 1416 Kaiser Permanente patients underwent liver or liver kidney transplant. 310 were included in the final analysis; 76% male and 24% female. 10.3% had recurrence of their HCC. 83% were within Milan criteria. 87% were transplanted for HBV (6) or HCV (21). There was no significant difference in time from UNOS listing to transplant, tumor size, or number of LRT between those with or without recurrence. Last pre-transplant AFP >400, female, and more tumors on explants were statistically significantly associated with higher HCC recurrence. 37 patients were transplanted within 6 months of diagnosis. The recurrence rate, for patients transplanted <6 months after diagnosis was 14% at 18 months and 27% at 48 months, compared to 6% and 10% for patients who were transplanted > 6 months post diagnosis.Figure: No Caption available.Conclusions: Patients transplanted within 6 months of diagnosis had projected recurrence rates double those transplanted later. Transplantation too soon after diagnosis may not be beneficial.