studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 637A
862
Clinical impact of 18 F-FDG-PET/CT in living donor liver
transplantation for advanced hepatocellular carcinoma
Seung Duk Lee, Eung Chang Lee, Seong Hoon Kim; Liver Cancer
Center, National Cancer Center, Republic of Korea, Goyang-si,
Korea (the Republic of)
Background: The relevant number of patients with hepatocellular
carcinoma (HCC) beyond the Milan criteria has undergone
living donor liver transplantation (LDLT). However, the prognostic
factors for these patients with advanced HCC are not
well established. Methods: From March 2005 to May 2013,
280 patients with HCC underwent LDLT in the National Cancer
Center. Among these, patients beyond the Milan criteria
were retrospectively enrolled. We analyzed the prognostic significance
of 18 F-fluorodeoxyglucose positron emission tomography/computed
tomography ( 18 F-FDG-PET/CT) for selecting
appropriate candidates. Results: Among total 280 patients,
147 patients (52.5%) were confirmed to have HCC beyond
the Milan criteria using pathological reports. The patients who
met and exceeded the Milan criteria had 5-year overall survival
(OS) rates of 87.2% and 64.6%, respectively, (p < 0.001). In
multivariable analysis for OS and DFS in patients beyond the
Milan criteria, PET/CT positivity [hazard ratio (HR) 2.714, p
= 0.013 for OS; HR 3.803, p < 0.001 for DFS], total tumor
size over 10 cm (HR 2.333, p = 0.035 for OS; HR 3.334, p
= 0.001 for DFS), and microvascular invasion (HR 2.917, p =
0.025 for DFS) were significant prognostic factors. In particular,
patients beyond the Milan criteria with a PET/CT-negative
status and total tumor size < 10 cm showed similar OS and
DFS in comparison with those within the Milan criteria. Conclusions:
A PET/CT status in LDLT is a useful marker to predict
survival of patients with advanced HCC.
Disclosures:
The following authors have nothing to disclose: Seung Duk Lee, Eung Chang Lee,
Seong Hoon Kim
863
Living or Deceased Donor Liver Transplantation for
Hepatocellular Carcinoma: A Western multicenter, intention
to treat, cohort study
Daniel Azoulay; HPB Surgery and liver transplant, Hopital Mondor
APHP, Creteil, France
Purpose. An intention-to-treat analysis of overall survival (ITT-OS)
in cirrhotic patients with hepatocellular carcinoma (HCC) listed
for either living donor (LDLT) [Group LiLDLT] or deceased donor
liver transplantation (DDLT), [Group LiDDLT] across 5 French
liver transplantation (LT) centers. Methods. Records of 861 cirrhotic
patients with HCC who were consecutively listed for
either LDLT (n=79) or DDLT (n=782) from 2000 to 2009 at 5
French centers were analyzed for ITT-OS using Cox model, and
for tumor recurrence using a competitive risk model. Results.
Tumour staging in both groups was similar. Among the listed
patients, 162 dropped-out (20.7%), all from Group LiDDLT (p <
0.0001). At 5-years, ITT-OS was significantly better for Group
LiLDLT vs Group LiDDLT (73.2% vs 66.7%;p = 0.062). Being
listed for LDLT (HR: 0.62 (0.40-0.98); p = 0.039), and MELD
score ≥ 25 at listing (HR: 1.79 (1.11-2.88); p = 0.017) were
independent predictors of ITT-OS. For the 699 transplanted
patients, 5-year OS post-LT (73.2% and 73.0%, p = 0.407)
and HCC recurrence (10.9 % and 11.2 %, p = 0.753) were
similar between those who had a living donor LT [Group LDLT]
and deceased donor LT [Group DDLT], respectively. Tumor
beyond Milan criteria (HR = 2.67 (1.5-4.7); p < 0.001), and
vascular invasion (HR = 2.52 (1.38;4.59); p = 0.003) were
independent predictors of recurrence whereas the type of LT
was not. Conclusion. LDLT improves ITT-OS by obviating dropout,
is not a risk factor of tumor recurrence, and hence should
be equally encouraged in countries where both, LDLT and DDLT
are available.
Disclosures:
The following authors have nothing to disclose: Daniel Azoulay
864
Third Liver Transplantation - Utility and Principles to
Guide Future Transplants; an Analysis of UNOS data
Vandana Khungar 1 , David S. Goldberg 1 , Peter L. Abt 2 ; 1 Medicine,
Division of Gastroenterology, University of Pennsylvania, Philadelphia,
PA; 2 Surgery, University of Pennsylvania, Philadelphia, PA
Background: Repeat liver transplantation (reLT), whether for
recurrent disease, vascular complications, or chronic rejection,
can be a lifesaving therapy. However, donor livers are
a scarce resource, with up to 20% of patients dying on the
waitlist before receiving their first transplant. As more patients
get further out from their 1 st (or 2 nd ) transplant, the transplant
community will need to consider the utility of 3 rd liver transplants.
Yet no data specifically addressing this question exist.
Methods: We performed a retrospective cohort study of all
adult patients listed for their third transplant, who were on
the waiting list between 2/28/02-12/31/2014, using UNOS
data. Kaplan-Meier analyses and log-rank tests were used to
evaluate post-transplant outcomes among the subset of patients
who received their third transplant. Results: 696 adult patients
were on the waitlist for a 3 rd transplant in this period. 362
(52.0%) received a 3 rd transplant, while 218 (31.3%) were
removed from the list for death or clinical deterioration. The
median recipient age was 47 (IQR: 34-45), median donor
risk index (DRI) was 1.33 (IQR: 1.15-1.58), with 211 (58.3%)
donors being under the age of 40. Median laboratory MELD at
transplant was 29 (21-36). The 1,3, and 5 year post-transplant
patient survival rates were 74.5%, 64.4%, and 57.2% respectively.
Graft and patient survival were not statistically different
between centers who had performed 1-9 3 rd transplants vs
≥10 3 rd transplants (p>0.05). Post-transplant patient survival
differed significantly (p=0.001) based on the transplant recipient’s
location at the time of 3 rd transplant. Conclusions: Patients
undergoing reLT were given optimal organs from young donors
with low DRI. Despite this, their post-transplant survival is lower
when compared to patients undergoing 1 st transplantation.
The survival rates among the subset transplanted from the ICU
are dramatically lower, and raise questions about the utility of
transplantation in these high-risk patients outside of the setting
of primary non function (PNF) or hepatic artery thrombosis
(HAT).