Clinical

Chemotherapy before liver transplant may not be necessary

Last Updated: 2004-11-01 17:50:13 -0400 (Reuters Health)

By Martha Kerr

BOSTON (Reuters Health) - Locoregional ablative therapy for hepatocellular carcinoma (HCC) does not appear to improve the outcome for patients undergoing liver transplantation since implementation of the current organ allocation system, researchers announced here at the 55th annual meeting of the American Association for the Study of Liver Diseases.

Dr. Kim Olthoff, of the University of Pennsylvania in Philadelphia, presented results of a retrospective study of 74 consecutive patients with HCC who underwent liver transplantation between February 28, 2002 and February 28, 2004. Thirty-two of these patients underwent pretransplant locoablative chemotherapy.

The study's time period is important, Dr. Olthoff noted, as the MELD organ allocation system, in which patients on the transplant waiting list receive points according to the severity to their disease, was implemented in 2002.

Waiting time to transplantation was similar for both treated and untreated patients, as were pathologic and histologic characteristics. All ablated tumors showed effects of treatment, but there was viable tumor remaining in 78% of treated explants, Dr. Olthoff said.

Dr. Olthoff reported that 12-month disease-free survival was not significantly different between treated and untreated patients. Disease-free survival at one year was 81% in treated patients and 90% in untreated patients. Overall survival was 87% in ablated patients and 90% in untreated patients.

"This is still a short follow-up period," Dr. Olthoff noted. She added that in the era of MELD, patients are on the waiting list for an average of 40 days before receiving liver transplantation.