Digestive Diseases and Sciences

, Volume 57, Issue 2, pp 580–586

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

Authors

    • Division of Digestive and Liver Diseases, Department of Internal MedicineUT Southwestern Medical Center
    • Parkland Memorial HospitalParkland Health and Hospital System
    • Department of Clinical SciencesUniversity of Texas Southwestern
    • Harold C. Simmons Cancer CenterUT Southwestern Medical Center
  • Vincent Chan
    • Division of Digestive and Liver Diseases, Department of Internal MedicineUT Southwestern Medical Center
    • Parkland Memorial HospitalParkland Health and Hospital System
  • Yonas Getachew
    • Division of Digestive and Liver Diseases, Department of Internal MedicineUT Southwestern Medical Center
    • Parkland Memorial HospitalParkland Health and Hospital System
  • Richard Guerrero
    • Division of Digestive and Liver Diseases, Department of Internal MedicineUT Southwestern Medical Center
    • Parkland Memorial HospitalParkland Health and Hospital System
  • Joan S. Reisch
    • Department of Clinical SciencesUniversity of Texas Southwestern
  • Jennifer A. Cuthbert
    • Division of Digestive and Liver Diseases, Department of Internal MedicineUT Southwestern Medical Center
    • Parkland Memorial HospitalParkland Health and Hospital System
Original Article

DOI: 10.1007/s10620-011-1904-7

Cite this article as:
Singal, A.G., Chan, V., Getachew, Y. et al. Dig Dis Sci (2012) 57: 580. doi:10.1007/s10620-011-1904-7

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.

Keywords

Hepatocellular carcinomaPresentationTumor stageLiver transplantationSafety net hospital

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

Supplementary material

10620_2011_1904_MOESM1_ESM.pdf (411 kb)
Supplementary material 1 (PDF 411 kb)

Copyright information

© Springer Science+Business Media, LLC 2011