Value of HCC-MELD score in patients with hepatocellular carcinoma undergoing liver transplantation

Gian Piero Guerrini, Domenico Pinelli, Elena Marini, Vittorio Corno, Michela Guizzetti, Marco Zambelli, Alessandro Aluffi, Lisa Lincini, Stefano Fagiuoli, Alessandro Lucianetti, Michele Colledan

Research output: Contribution to journalArticlepeer-review

Abstract

Context: Liver transplantation (LT) is considered the ideal therapy for patients with hepatocellular carcinoma (HCC) having cirrhosis but the shortage of liver donors and the risk of dropout from the wait list due to tumor progression severely limit transplantation. A new prognostic score, the HCC-model for end-stage liver disease (HCC-MELD), was developed by combining a-fetoprotein (AFP), MELD, and tumor size, to improve risk stratification of dropout in patients with HCC. Objectives: In this study, we investigated the ability of the HCC-MELD score in predicting the posttransplant for patients fulfilling Milan criteria (MC). Design: Two hundred patients with stage II tumor were retrospectively reviewed from a total of 1290 transplants performed at our institution from October 1997 through April 2015. Cox regression analysis was performed to identify the prognostic factors impacting the posttransplant survival. Results: Overall survival at 1, 5, and 10 years was 89.3%, 71.1%, and 67.2%, whereas disease-free survival was 86.4%, 66.5%, and 52.4%, respectively. Multivariate analysis showed HCC-MELD score (hazard ratio [HR] 39.6, P < .001) and microvascular invasion (HR 2.41, P = .002) to be independent risk factors for recurrence, whereas HCC diameter (HR 1.15, P = .041), HCC-MELD (HR 15.611, P = .006), and grading (HR 2.17, P = .03) proved to be predictive factors of poor overall survival. Conclusion: Our study showed the validity of the HCC-MELD equation in the evaluation of patients undergoing LT for HCC. This score offers a reliable method to assess the risk of waiting list dropout and predict posttransplantation outcomes.

Original languageEnglish
Pages (from-to)63-69
Number of pages7
JournalProgress in Transplantation
Volume28
Issue number1
DOIs
Publication statusPublished - Mar 1 2018

Keywords

  • HCC-MELD
  • Hepatocellular carcinoma
  • Liver transplantation
  • Liver tumor
  • MELD
  • Milan criteria

ASJC Scopus subject areas

  • Transplantation

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