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Predictors of Liver Transplant Eligibility for Patients with Hepatocellular Carcinoma in a Safety Net Hospital

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Abstract

Background

Liver transplantation for patients with hepatocellular carcinoma (HCC) affords excellent long-term survival but is limited to patients with early stage tumors. Predictors for orthotopic liver transplantation eligibility are not well defined for patients in a safety-net hospital system.

Aims

To clarify the clinical presentation of HCC and define predictors for early stage disease in a racially diverse safety-net hospital system.

Methods

We retrospectively reviewed records of patients with HCC presenting to a large urban county hospital between January 1998 and October 2007. Logistic regression analysis was used to find predictors of OLT eligibility.

Results

Of the 266 patients with HCC, 62% had multiple tumors, 47% had portal vein thrombosis and only 22% were potential liver transplant candidates based on Milan criteria. Male gender (OR 0.33; 95% CI 0.17–0.65) and AFP levels > 20 ng/mL (OR 0.22; 95% CI 0.11–0.45) were negative predictors of liver transplant eligibility. Age, race, and underlying viral liver disease were not significant predictors of early tumor stage.

Conclusions

A minority of HCC patients in a safety-net hospital are eligible for liver transplant at the time of diagnosis. Men have more advanced tumors at presentation, which may be related to more aggressive tumor biology or differential rates of HCC surveillance.

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Abbreviations

AASLD:

American Association for the Study of Liver Disease

AFP:

Alpha fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

NASH:

Nonalcoholic steatohepatitis

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

OLT:

Orthotopic liver transplantation

PMH:

Parkland Memorial Hospital

PVT:

Portal vein thrombus

SEER:

Surveillance, Epidemiology, and End Results

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Acknowledgment

This project was supported, in part, by grant KL2 RR024983-04.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, 1801 Inwood Rd Suite 4.420B, Dallas, TX, 75390, USA

    Amit G. Singal, Vincent Chan, Yonas Getachew, Richard Guerrero & Jennifer A. Cuthbert

  2. Parkland Memorial Hospital, Parkland Health and Hospital System, Dallas, TX, USA

    Amit G. Singal, Vincent Chan, Yonas Getachew, Richard Guerrero & Jennifer A. Cuthbert

  3. Department of Clinical Sciences, University of Texas Southwestern, Dallas, TX, USA

    Amit G. Singal & Joan S. Reisch

  4. Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA

    Amit G. Singal

Authors
  1. Amit G. Singal
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  2. Vincent Chan
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  3. Yonas Getachew
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  4. Richard Guerrero
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  5. Joan S. Reisch
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  6. Jennifer A. Cuthbert
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Corresponding author

Correspondence to Amit G. Singal.

Additional information

Amit G. Singal and Vincent Chan contributed equally to this manuscript and are co-first authors.

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Singal, A.G., Chan, V., Getachew, Y. et al. Predictors of Liver Transplant Eligibility for Patients with Hepatocellular Carcinoma in a Safety Net Hospital. Dig Dis Sci 57, 580–586 (2012). https://doi.org/10.1007/s10620-011-1904-7

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  • DOI: https://doi.org/10.1007/s10620-011-1904-7

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