Is there a Benefit from Rescue-Allocated Organs for HCCPatients Staged outside the Milan Criteria?

Objective: For hepatocellular carcinoma (HCC) a 5-year survival rate over 75% is achieved within Milan-criteria (MC), but expanded criteria (UCSF- and Bologna-criteria) show similar survival rates.Management of the waiting list remains controversial and living donation and rescue allocation may help to reduce waiting time for patients outside MC in Germany.

Methods: 110 Patients listed for liver transplantation at UKSH Kiel from 1998 - 2014 with HCC were analysed. Assuming that patients outside the MC had a longer waiting time for primary-donor organs, we compared the outcome of patients with rescue-allocated organs outside the MC and primary-allocated organs. Studied parameters were impact of MC, allocation-mode, waiting time, radiological and histological tumour-assessment and the impact of bridging therapy on the outcome after transplantation.

Results: Radiological tumour-assessment compared to pathological report of the explant liver differed in 28%. Patients allocated by rescue-allocated donor organs had a significant shorter waiting time, but 5-year tumour free survival was significantly worse compared to primarily allocated organs. Patients within and beyond MC but within UCSF-criteria as well as patients receiving TACE inside and outside MC showed no significant difference in survival rates. Multilocular tumour lesions and a cumulative tumour size >8 cm had a significant impact on 5-year survival and tumour-free survival.

Conclusion: Rescue-allocated organs may help to reduce waiting time for patients with a no-progressive tumour disease outside MC. Radiological assessment was not optimal to stratify HCC-patients on the waiting list. Besides MC and TACE standardized radiological assessment, additional parameters and biomarkers could help to improve survival and select patients for transplantation by monitoring the aggressiveness of tumour growth.