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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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