Reuters Health Information (2007-03-09): Survival of hepatitis B liver transplant candidates not dependent on cancer status
Survival of hepatitis B liver transplant candidates not dependent on cancer status
Last Updated: 2007-03-09 12:18:09 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Among liver transplant candidates with chronic hepatitis B, survival is comparable for those listed with cirrhosis versus those with hepatocellular carcinoma (HCC).
Patients with HCC typically receive a higher transplant priority score than those with cirrhosis, resulting in earlier transplantation and possibly reduction in waiting list mortality, according to the report in the March issue of Liver Transplantation. However, survival following transplantation may be reduced in HCC patients due to the risk of disease recurrence.
To compare survival in hepatitis B patients undergoing liver transplantation for cirrhosis versus cancer, Dr. Stephen N. Wong, from the University of Michigan in Ann Arbor, and colleagues analyzed data from 279 patients enrolled in the US Hepatitis B Virus-Orthotopic Liver Transplantation study. The median follow-up period was 30.2 months from first appearance on the transplant list.
The transplantation rate in HCC patients was significantly higher than that in cirrhotics: 78.1% vs. 51.4%. However, intention-to-treat survival and survival without transplantation were comparable in each group, hovering around 75% and 80%, respectively.
Predictors of improved intention-to-treat survival were higher albumin, lower transplant priority score, no cancer at listing, and undergoing transplantation.
Following transplantation, the survival rate in the cancer group was 83%, not significantly different from the 90% rate noted in the cirrhotic group. The HBV recurrence rate was also similar in each group, roughly 10%. Disease recurrence, by contrast, was significantly higher in the cancer group: 19% vs. 10%.
"The one very clear message provided by this paper is that United Network for Organ Sharing algorithm granting priority to patients with HCC meeting Milan criteria results in a high likelihood that these patients will undergo liver transplantation. At least in the case of patients with hepatitis B virus, this result appears to have been achieved without impacting the outcome for nontumor patients," Dr. Myron Schwartz and colleagues, from the Mount Sinai School of Medicine in New York, note in a related editorial.
Liver Transpl 2007;13:316-317,334-342.