Intention to treat survival following liver transplantation for hepatocellular carcinoma within a donor service area

Background. This study aimed to assess the impact of wait times on patient survival following liver transplantation for hepatocellular carcinoma (HCC) in a single donor service area. Patients and methods. Patients listed in the New England Organ Bank (NEOB) from 1996 to 2005 for liver transplantation with a diagnosis of HCC were identified from the United Network for Organ Sharing database. The following data were extracted: date of listing, date removed from the wait list, indication for wait list removal, patient death and date of last known follow-up. Kaplan-Meier survival estimates were calculated from the time of listing for transplant (intention to treat liver transplant survival, ITT OLT) and compared to those calculated from the date of transplant (liver transplant, OLT). Results. There were 63 new registrations to the transplant list during the study period. Sixty-one patients were removed from the waiting list: transplanted 41 (65%), death seven (11%), candidate condition deteriorated/too sick to transplant eight (13%), medically unsuitable one (2%), other one (2%), transferred to another center two (3%), and transplanted at another center one (2%). Three-year survival following liver transplantation for primary liver cancer was 85%. When the results were analyzed using an intention to treat analysis there was a 10-20% decrease in survival rate at every time point due to wait list drop-out. Conclusion. Wait list drop-out adversely affects liver transplant survival in transplant centers served by the NEOB. These data should be considered when recommending transplant versus resection as first line therapy for stage I or II HCC in our region.