Candidates for liver transplant with hepatocellular carcinoma listed in the long waiting time regions had higher overall survival rates compared with patients in the short waiting time list regions, according to new study data.
Researchers analyzed results from the United Network for Organ Sharing (UNOS) database of 6,166 patients with HCC granted exception points for liver transplantation in regions 3, 5, 9 and 10 between February 2002 and July 2012. Data for regions 5 and 9 (long waiting times) were compared with data from regions 3 and 10 (short waiting time) to determine disparities in organ access and possible outcomes and their effects when prioritizing HCC patients for transplant.
Survival rates were measured in three cohorts: intent-to-treat, post-transplant and overall survival in transplanted patients. The median time on the patient wait list for long regions was 7.6 months vs. 1.6 months for the short regions.
Survival was better among patients in the long regions compared with the short regions in all three cohorts (P<.0001 for all). In each cohort, 5-year survival rates were greater in the long regions vs. the short: intent-to-treat (70% vs. 66%), post-transplant (69% vs. 65%) and overall survival (75% vs. 67%). There was, however, a higher incidence of death on the long regions wait list (8.4% vs. 1.6%; P<.0001). Transplantation was the most common outcome among both groups of regions (94% in short and 78% in long).
Multivariate analysis showed that being placed on a wait list or undergoing transplantation in a short region was found to be an independent predictor of poor patient survival (HR=1.545; 95% CI, 1.375-1.736).
“Expediting patients with HCC to transplant at too fast a rate adversely affects outcomes, with a more than 8% difference in post-transplant survival between short and long access time regions,” the researchers concluded. “Because overall waiting time is an independent predictor of poor outcome, we would suggest that further iterations in allocation policy toward HCC be considered.”
Disclosure: Rachel E. Patzer, PhD, MPH, received grants from Bristol-Myers Squibb.