Waiting Time and Explant Pathology in Transplant Recipients With Hepatocellular Carcinoma: A Novel Study Using National Data.

Abstract

Risk factors for hepatocellular carcinoma (HCC) recurrence after liver transplantation have been well described. It has been surmised that longer time on the waitlist may select for tumors with a lower risk of recurrence post-transplant, as patients with unfavorable tumor characteristics would be delisted due to tumor progression. Utilizing national explant pathology records from transplant recipients waitlisted with T2 HCC exception points, this study explored the correlation between waiting time and the development of pathologic HCC features associated with increased risk of tumor recurrence. Of 1,929 explant pathology reports submitted nationally between 4/8/2012 and 6/30/2013, 1,453 (73.5%) were from recipients with automatic T2 HCC exception points. There was no association between pre-transplant waiting time and the proportion of HCC explants with either: 1) a poorly differentiated tumor; 2) macrovascular invasion; 3) HCC beyond Milan or UCSF criteria; 4) HCC beyond the “up-to-seven” criteria; or 5) extrahepatic or lymph node involvement. Though there was a statistically significant increase in microvascular invasion in recipients with pre-transplant waiting 6-12 months, this association was not seen when adjusted for United Network for Organ Sharing region. These findings suggest that waiting time alone may not select for tumors with more favorable characteristics. DISCLOSURES:Goldberg, D.: Grant/Research Support, Bayer Healthcare.