Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System
Liver transplantation (LT) is the only definitive treatment to cure hepatocellular carcinoma (HCC) in cirrhosis. Waiting-list candidates are selected by the model for end-stage liver disease (MELD). However, many indications are not sufficiently represented by labMELD. For HCC, patients are selected...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/5/1136 |
| _version_ | 1797475538979258368 |
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| author | Jan-Paul Gundlach Michael Linecker Henrike Dobbermann Felix Wadle Thomas Becker Felix Braun |
| author_facet | Jan-Paul Gundlach Michael Linecker Henrike Dobbermann Felix Wadle Thomas Becker Felix Braun |
| author_sort | Jan-Paul Gundlach |
| collection | DOAJ |
| description | Liver transplantation (LT) is the only definitive treatment to cure hepatocellular carcinoma (HCC) in cirrhosis. Waiting-list candidates are selected by the model for end-stage liver disease (MELD). However, many indications are not sufficiently represented by labMELD. For HCC, patients are selected by Milan-criteria: Milan-in qualifies for standard exception (SE) and better organ access on the waiting list; while Milan-out patients are restricted to labMELD and might benefit from extended criteria donor (ECD)-grafts. We analyzed a cohort of 102 patients (2011–2020). Patients with labMELD (no SE, Milan-out, <i>n</i> = 56) and matchMELD (SE-HCC, Milan-in, <i>n</i> = 46) were compared. The median overall survival was not significantly different (<i>p</i> = 0.759). No difference was found in time on the waiting list (<i>p</i> = 0.881), donor risk index (<i>p</i> = 0.697) or median costs (<i>p</i> = 0.204, EUR 43,500 (EUR 17,800–185,000) for labMELD and EUR 30,300 (EUR 17,200–395,900) for matchMELD). Costs were triggered by a cut-off labMELD of 12 points. Overall, the deficit increased by EUR 580 per labMELD point. Cost drivers were re-operation (<i>p</i> < 0.001), infection with multiresistant germs (<i>p</i> = 0.020), dialysis (<i>p</i> = 0.017), operation time (<i>p</i> = 0.012) and transfusions (<i>p</i> < 0.001). In conclusion, this study demonstrates that LT for HCC is successful and cost-effective in low labMELD patients independent of Milan-criteria. Therefore, ECD-grafts are favorized in Milan-out HCC patients with low labMELD. |
| first_indexed | 2024-03-09T20:45:33Z |
| format | Article |
| id | doaj.art-4fed9a4130c74a83875d33001760efb9 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T20:45:33Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-4fed9a4130c74a83875d33001760efb92023-11-23T22:46:24ZengMDPI AGCancers2072-66942022-02-01145113610.3390/cancers14051136Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care SystemJan-Paul Gundlach0Michael Linecker1Henrike Dobbermann2Felix Wadle3Thomas Becker4Felix Braun5Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, GermanyDepartment of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, GermanyDepartment of Internal Medicine-Hepatology, UKSH Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyDepartment of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, GermanyDepartment of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, GermanyDepartment of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, UKSH Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, GermanyLiver transplantation (LT) is the only definitive treatment to cure hepatocellular carcinoma (HCC) in cirrhosis. Waiting-list candidates are selected by the model for end-stage liver disease (MELD). However, many indications are not sufficiently represented by labMELD. For HCC, patients are selected by Milan-criteria: Milan-in qualifies for standard exception (SE) and better organ access on the waiting list; while Milan-out patients are restricted to labMELD and might benefit from extended criteria donor (ECD)-grafts. We analyzed a cohort of 102 patients (2011–2020). Patients with labMELD (no SE, Milan-out, <i>n</i> = 56) and matchMELD (SE-HCC, Milan-in, <i>n</i> = 46) were compared. The median overall survival was not significantly different (<i>p</i> = 0.759). No difference was found in time on the waiting list (<i>p</i> = 0.881), donor risk index (<i>p</i> = 0.697) or median costs (<i>p</i> = 0.204, EUR 43,500 (EUR 17,800–185,000) for labMELD and EUR 30,300 (EUR 17,200–395,900) for matchMELD). Costs were triggered by a cut-off labMELD of 12 points. Overall, the deficit increased by EUR 580 per labMELD point. Cost drivers were re-operation (<i>p</i> < 0.001), infection with multiresistant germs (<i>p</i> = 0.020), dialysis (<i>p</i> = 0.017), operation time (<i>p</i> = 0.012) and transfusions (<i>p</i> < 0.001). In conclusion, this study demonstrates that LT for HCC is successful and cost-effective in low labMELD patients independent of Milan-criteria. Therefore, ECD-grafts are favorized in Milan-out HCC patients with low labMELD.https://www.mdpi.com/2072-6694/14/5/1136HCChepatocellular carcinomaliver transplantationmatchMELDfinancial burdenorgan shortage |
| spellingShingle | Jan-Paul Gundlach Michael Linecker Henrike Dobbermann Felix Wadle Thomas Becker Felix Braun Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System Cancers HCC hepatocellular carcinoma liver transplantation matchMELD financial burden organ shortage |
| title | Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System |
| title_full | Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System |
| title_fullStr | Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System |
| title_full_unstemmed | Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System |
| title_short | Patients Benefit from Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria without Harming the Health Care System |
| title_sort | patients benefit from liver transplantation for hepatocellular carcinoma beyond milan criteria without harming the health care system |
| topic | HCC hepatocellular carcinoma liver transplantation matchMELD financial burden organ shortage |
| url | https://www.mdpi.com/2072-6694/14/5/1136 |
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