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Survival Benefit of Liver Transplantation Versus Resection for Hepatocellular Carcinoma: Impact of MELD Score

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to measure the impact of model for end stage liver disease (MELD) score, tumor staging, and microvascular invasion (MVI) on the relative survival benefit of liver transplantation (LT) versus liver resection (LR) for hepatocellular carcinoma (HCC).

Methods

The study population comprised 1,106 HCC patients with cirrhosis undergoing LR from one Eastern (n = 424) and two Western (n = 682) surgical units. Exclusion criteria were very large (>10 cm) tumors, macrovascular invasion, and metastases. We identified three tumor stages: stage I (within Milan, n = 806), stage II (beyond Milan within Up-to-7, n = 123), and stage III (beyond Milan and Up-to-7, n = 177). Patient survival after LR was compared to that predicted after LT by the Metroticket calculator in relationship with staging, MVI, and MELD score using Monte Carlo simulation.

Results

Two hundred eighty-three patients (26 %) with a MELD score of ≥10 had an acceptable 5-year survival after LR of 47 %, while that of patients with a low MELD score was 67 % (p < 0.0001). Mean 5-year LT benefit was −4.50 months (95 % confidence interval [CI] −4.73 to −4.27) for patients with a MELD score of <10, and 0.81 months (95 % CI 0.58 to 1.04) for those with a MELD score of ≥10. MELD score and MVI were the strongest predictors of transplant survival benefit. LT reached a survival benefit, versus LR only in HCC patients with a MELD score of ≥10 and without MVI (3.08 months, 95 % CI 2.78 to 3.39), whatever the tumor stage.

Conclusions

LT proved to be harmful in patients with resectable HCC with a low MELD score (<10) or with aggressive tumors (with MVI). As a result of a shortage of donors, only selected resectable tumors with a MELD score of ≥10 should be considered for transplantation.

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Disclosure

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Authors and Affiliations

  1. Hepatobiliary Surgery and Liver Transplantation Unit, Department of General Surgery and Organ Transplantation, University Hospital of Padua, Padua, Italy

    Alessandro Vitale MD, PhD, Francesco Tuci MD & Umberto Cillo MD

  2. National Yang-Ming University, Taipei, Taiwan

    Teh-la Huo MD & Yun-Hsuan Lee MD

  3. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Teh-la Huo MD & Yun-Hsuan Lee MD

  4. Liver and Multiorgan Transplantation Unit, St. Orsola Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Alessandro Cucchetti MD, Matteo Cescon MD & Antonio Daniele Pinna MD

  5. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA

    Michael Volk MD

  6. Biostatistics Unit, University of Padua, Padua, Italy

    Anna Chiara Frigo PhD

Authors
  1. Alessandro Vitale MD, PhD
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  2. Teh-la Huo MD
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  3. Alessandro Cucchetti MD
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  4. Yun-Hsuan Lee MD
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  5. Michael Volk MD
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  6. Anna Chiara Frigo PhD
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  7. Matteo Cescon MD
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  8. Francesco Tuci MD
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  9. Antonio Daniele Pinna MD
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  10. Umberto Cillo MD
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Correspondence to Alessandro Vitale MD, PhD.

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Vitale, A., Huo, Tl., Cucchetti, A. et al. Survival Benefit of Liver Transplantation Versus Resection for Hepatocellular Carcinoma: Impact of MELD Score. Ann Surg Oncol 22, 1901–1907 (2015). https://doi.org/10.1245/s10434-014-4099-2

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  • DOI: https://doi.org/10.1245/s10434-014-4099-2

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