Study Shows Excellent Post-Transplant Outcomes Following Down-Staging of HCC Patients

Successful downstaging of selected patients with HCC (hepatocellular carcinoma) before liver transplantation leads to excellent 5-year recurrence-free and overall survival rates post-transplant, according to a just-reported multicenter study led by UCSF Transplant Program investigators. Medscape Medical News reported on these results at the Liver Meeting 2014: American Association for the Study of Liver Diseases (AASLD) where the UCSF study findings were presented:

Treating lesions with local-regional therapy allowed 119 of 187 patients with hepatocellular carcinoma to become eligible for liver transplant, and 80% of transplanted patients lived at least 5 years after surgery, said Neil Mehta, MD, from the University of California at San Francisco (UCSF).

"Successful downstaging to the Milan criteria was achieved in nearly two thirds of our patients," he reported here at The Liver Meeting 2014.

The Milan criteria are considered by many clinicians to be the gold standard for selecting patients with cirrhosis and hepatocellular carcinoma for transplantation. According to the criteria, patients with one lesion no larger than 5 cm or two or three lesions no larger than 3 cm can be considered for transplantation.

To be eligible for priority listing for liver transplant in the United States, patients must meet the conventional stage T2 criteria of one lesion 2 to 5 cm in diameter with no vascular invasion, or multiple tumors that are not larger than 5 cm.

With local-regional therapy, either radiofrequency ablation of tumors or transcatheter arterial chemoembolization, some of these patients can meet the Milan criteria.

Dr. Mehta and colleagues looked at outcomes at three transplant centers. All follow the downstaging protocol developed at UCSF.