RISK FACTORS ASSOCIATED WITH DELISTING OF HEPATOCELLULAR CARCINOMA PATIENT'S CANDIDATES FOR LIVER TRANSPLANTATION

Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with morethan 1 million new cases diagnosed every year. Liver transplantation has been used as a curativetreatment for patients with HCC.Liver transplantation offers the best cure chance for unrespectable hepatocellular carcinoma(HCC), but the scarcity of cadaver liver grafts has seriously limited its role. With the recent advancesin adult living donor liver transplantation (LDLT), there is potentially a drastic change inthe role of liver transplantation. Recent Studies have demonstrated the theoretical survival benefitof LDLT over deceased donor liver transplantation (DDLT) which depends largely on thewaiting time and drop‐out rate. This study was conducted to analyze the different risk factorsleading to delisting in liver transplant patients with hepatocellular carcinoma. Fifty patients presentedto Ain Shams Specialized Hospitals from January 2017 to June 2018, with expected averagehepatocellular carcinoma eligible for Adult Living Donor Liver transplantation (ALDLT) werestudied. They were evaluated according to protocol of Ain Shams Center of Organ Transplantation(ASCOT). Inclusion criteria: 1-hepatocellular carcinoma with any underlying cause ofcirrhosis. HCC is first diagnosed using spiral computed tomography of liver and sometimesMagnetic Resonance Imaging (MRI). 2- Patients within University of California San Francisco(UCSF) criteria (one tumor ≤6·5 cm, three nodules with largest ≤4·5cm, & total tumor diameter≤8 cm). 3- Patients within these criteria underwent loco-regional therapy as bridging therapy includingradiofrequency ablation, radio-embolization, trans-arterial chemoembolization, microwaveablation or liver resection to avoid delisting. 4- Patients beyond these criteria underwentloco-regional treatment as means of down staging to be within Milan or UCSF and candidatesfor ALDLT. Exclusion criteria: 1- metastatic HCC patients, 2- macrovascular invasion, & 3-poor general condition for surgery.