RISK FACTORS ASSOCIATED WITH DELISTING OF HEPATOCELLULAR CARCINOMA PATIENT'S CANDIDATES FOR LIVER TRANSPLANTATION

MOHAMED, RASHA SAMIR; EL-KARMOUTY, KHALED ZAKARIA; AHMED, MOHAMED MOHAMED BAHAA ELDIN; ESKANDAR, ENGY EZZAT; El KILANY, HESHAM HAMDY; RASMY, HANY SAMIR

doi:10.21608/jesp.2020.131119

RISK FACTORS ASSOCIATED WITH DELISTING OF HEPATOCELLULAR CARCINOMA PATIENT'S CANDIDATES FOR LIVER TRANSPLANTATION

Document Type : Original Article

Authors

¹ Department of Internal Medicine

² Department of Surgery

10.21608/jesp.2020.131119

Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with more
than 1 million new cases diagnosed every year. Liver transplantation has been used as a curative
treatment for patients with HCC.
Liver transplantation offers the best cure chance for unrespectable hepatocellular carcinoma
(HCC), but the scarcity of cadaver liver grafts has seriously limited its role. With the recent advances
in adult living donor liver transplantation (LDLT), there is potentially a drastic change in
the role of liver transplantation. Recent Studies have demonstrated the theoretical survival benefit
of LDLT over deceased donor liver transplantation (DDLT) which depends largely on the
waiting time and drop‐out rate. This study was conducted to analyze the different risk factors
leading to delisting in liver transplant patients with hepatocellular carcinoma. Fifty patients presented
to Ain Shams Specialized Hospitals from January 2017 to June 2018, with expected average
hepatocellular carcinoma eligible for Adult Living Donor Liver transplantation (ALDLT) were
studied. They were evaluated according to protocol of Ain Shams Center of Organ Transplantation
(ASCOT). Inclusion criteria: 1-hepatocellular carcinoma with any underlying cause of
cirrhosis. HCC is first diagnosed using spiral computed tomography of liver and sometimes
Magnetic Resonance Imaging (MRI). 2- Patients within University of California San Francisco
(UCSF) criteria (one tumor ≤6·5 cm, three nodules with largest ≤4·5cm, & total tumor diameter
≤8 cm). 3- Patients within these criteria underwent loco-regional therapy as bridging therapy including
radiofrequency ablation, radio-embolization, trans-arterial chemoembolization, microwave
ablation or liver resection to avoid delisting. 4- Patients beyond these criteria underwent
loco-regional treatment as means of down staging to be within Milan or UCSF and candidates
for ALDLT. Exclusion criteria: 1- metastatic HCC patients, 2- macrovascular invasion, & 3-
poor general condition for surgery.

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