An analysis of waiting times and tumor growth in patients needing liver transplants for hepatocellular carcinoma indicates national wait-listing policy should be changed. The average wait for these patients of nearly a year means tumors could grow too large to be cured with transplantation, reports a University of Pittsburgh surgeon at Transplant 2000, the first combined scientific sessions of the American Society of Transplant Surgeons and the American Society of Transplantation. The meeting is being held May 13-17 at the Sheraton Chicago Hotel and Towers.
While a United Network for Organ Sharing (UNOS) policy allows patients with Stage I and II hepatocellular carcinoma (HCC) to be upgraded on the UNOS waiting list from status 3 to status 2B, this decreases the average waiting time by only 18 days, from 341 days to 323. According to a University of Pittsburgh analysis, the mean waiting time of nearly a year for patients of either status is sufficient time for their tumors to go through 1.5 to three doublings, which may render the tumors too large to cure.
These patients ought to be listed in the more urgent category -- status 2A, which has a mean waiting time of 116 days, equivalent to one tumor doubling time, says Wallis Marsh, M.D., who presented results of his study today.
Dr. Marsh, associate professor of surgery at the Thomas E. Starzl Transplantation Institute, examined 344 HCC patients transplanted at the University of Pittsburgh. All tumor Stage I patients were alive and tumor-free at five years; tumor Stage II patients had a 93 percent five-year tumor-free survival rate. Stage I is defined by the American Liver Tumor Study Group as a cancer that involves one nodule less than 2 cm in size; Stage II is characterized by either one nodule of 2 to 5 cm or two to three nodules less than 3 cm. Stage III patients (those with one nodule greater than 5 cm or two to three nodules one of which is greater than 3 cm) and stage IV-A1 patients (those with four or more nodules of any size) had five-year tumor-free survival rates of 64 percent and 52 percent, respectively.
Modifying the staging system to select a subgroup of Stage IV patients with four or more nodules all less than 3 cm results in an 80 percent five-year survival rate.
"Such outcomes justify a change in policy to allow these patients to be upgraded as well, but to status 2A, not status 2B," Dr. Marsh argued.
Nearly 70 presentations on clinical and basic science research findings are being presented by University of Pittsburgh transplant researchers at Transplant 2000. Other papers include results using livers from nonheart-beating donors, the causes and rates of retransplantation in 4,000 liver transplants at the Pittsburgh center and an analysis that reveals a potential screening tool for patients likely to experience frequent rejections.
Contact: Maureen McGaffin
412-624-2607
FAX: 412-624-3184
Mcgaffinme@msx.upmc.edu