INDICATION FOR LIVER TRANSPLANTATION DUE TO HEPATOCELLULAR CARCINOMA: ANALYSIS OF 1,706 PROCEDURES OVER THE PAST DECADE IN THE STATE OF PARANÁ

Freitas, Alexandre Coutinho Teixeira de; Espinoza, Fátima Diana Samúdio; Mattar, Cristina Alvarez; Coelho, Júlio Cezar Uili

doi:10.1590/0102-672020220002e1701

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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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Original Article • ABCD, arq. bras. cir. dig. 35 • 2022 • https://doi.org/10.1590/0102-672020220002e1701 copy

INDICATION FOR LIVER TRANSPLANTATION DUE TO HEPATOCELLULAR CARCINOMA: ANALYSIS OF 1,706 PROCEDURES OVER THE PAST DECADE IN THE STATE OF PARANÁ

INDICAÇÃO DE TRANSPLANTE HEPÁTICO POR HEPATOCARCINOMA: ANÁLISE DE 1.706 PROCEDIMENTOS NA ÚLTIMA DÉCADA NO ESTADO DO PARANÁ

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Patients listed for liver transplantation and hepatocellular carcinoma are considered priority on the waiting list, and this could overly favor them.

AIM:

This study aimed to evaluate the impact of this prioritization.

METHODS:

We analyzed the liver transplants performed in adults from 2011 to 2020 and divided into three groups: adjusted Model of End-Stage Liver Disease (MELD) score for hepatocellular carcinoma, other adjusted Model of End-Stage Liver Disease situations, and no adjusted Model of End-Stage Liver Disease.

RESULTS:

A total of 1,706 patients were included in the study, of which 70.2% were male. Alcoholism was the main etiology of cirrhosis (29.6%). Of the total, 305 patients were with hepatocellular carcinoma, 86 with other adjusted Model of End-Stage Liver Disease situations, and 1,315 with no adjusted Model of End-Stage Liver Disease. Patients with hepatocellular carcinoma were older (58.9 vs. 53.5 years). The predominant etiology of cirrhosis was viral hepatitis (60%). The findings showed that group with adjusted Model of End-Stage Liver Disease had lower physiological Model of End-Stage Liver Disease (10.9), higher adjusted Model of End-Stage Liver Disease (22.6), and longer waiting list time (131 vs. 110 days), as compared to the group with no adjusted Model of End-Stage Liver Disease. The total number of transplants and the proportion of patients transplanted for hepatocellular carcinoma increased from 2011 to 2020. There was a reduction in the proportion of patients with hepatocellular carcinoma and adjusted Model of End-Stage Liver Disease of 20 and there was an increase on waiting list time in this group. There was an increase in the proportion of those with adjusted Model of End-Stage Liver Disease of 24 and 29, but the waiting list time remained stable.

CONCLUSION:

Over the past decade, prioritization of hepatocellular carcinoma resulted in an increased proportion of transplanted patients in relation to those with no priority. It also increased waiting list time, requiring higher adjusted Model of End-Stage Liver Disease to transplant an organ.

HEADINGS:
Liver Transplantation; Carcinoma, Hepatocellular; Waiting Lists

		Adjusted MELD score for HCC	Other adjusted MELD score situations	No adjusted MELD score	Total	p-value
n (%)		305 (17.9)	86 (5.0)	1,315 (77.1)	1,706 (100)
Gender, n (%)
	Male	234 (76.7)	42 (48.8)	921 (70.0)	1,197 (70.2)	<0.001^* * Chi-square;
	Female	71 (23.3)	44 (51.2)	394 (30.0)	509 (29.8)
Age (years)		58.9 ± 8.7	48 ± 12.9	52.6±11.3	53.5±11.3	<0.001^* * Chi-square;
Etiology of cirrhosis, n (%)
	Alcohol	52 (17.0)	8 (9.3)	445 (33.8)	505 (29.6)	<0.001^* * Chi-square;
	Viral hepatitis	183 (60.0)	8 (9.3)	292 (22.2)	483 (28.3)	<0.001^* * Chi-square;
	Cryptogenic	14 (4.6)	2 (2.3)	188 (14.3)	204 (12.0)	<0.001^* * Chi-square;
	Other	23 (7.5)	56 (65.1)	114 (8.7)	193 (11.3)	<0.001^* * Chi-square;
	NASH	24 (7.9)	2 (2.3)	117 (8.9)	143 (8.4)	0.097^* * Chi-square;
	Autoimmune hepatitis	3 (1.0)	3 (3.5)	69 (5.2)	75 (4.4)	0.004^* * Chi-square;
	Primary biliary cirrhosis	4 (1.3)	6 (7.0)	29 (2.2)	39 (2.3)	0.007^* * Chi-square;
	Fulminant hepatitis	1 (0.3)	0 (0.0)	35 (2.7)	36 (2.1)	0.014^* * Chi-square;
	Secondary biliary cirrhosis	1 (0.3)	1 (1.2)	26 (2.0)	28 (1.6)	0.116^* * Chi-square;
MELD		10.9	15.4	21.8	19.5	<0.001^* * Chi-square;
Adjusted MELD score		22.6	26.9	21.8	23.5	<0.001^* * Chi-square;
Waiting time (days)		131.9	131.4	110.6	115.4	<0.001^* * Chi-square;

Year	Adjusted MELD score for HCC^* * Chi-square; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease. n (%)	Other adjusted MELD score situations n (%)	No adjusted MELD scores n (%)	Total	p-value
2011	10 (21.3)	0 (0.0)	37 (78.7)	47	<0.001^* * Chi-square; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2012	19 (20.6)	2 (2.2)	71 (77.2)	92
2013	27 (26.7)	5 (5.0)	69 (68.3)	101
2014	28 (31.1)	6 (6.7)	56 (62.2)	90
2015	36 (28.6)	10 (7.9)	80 (63.5)	126
2016	31 (14.8)	13 (6.2)	166 (79.0)	210
2017	32 (12.1)	3 (1.1)	230 (86.8)	265
2018	45 (14.9)	18 (6.0)	238 (79.1)	301
2019	35 (13.9)	10 (4.0)	207 (82.1)	252
2020	42 (18.9)	19 (8.6)	161 (72.5)	222
Total	305	86	1,315	1,706

Year	Adjusted MELD score for HCC		Other adjusted MELD score situations		No adjusted MELD score	p-value
Year	MELD	Adjusted MELD	MELD	Adjusted MELD	MELD	p-value
2011	11.5	20.4	–	–	19.4	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2012	11.1	20.8	17.0	40.0	20.9	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2013	10.6	22.1	16.8	28.8	21.2	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2014	10.8	24.0	24.3	34.3	23.6	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2015	12.1	22.9	10.6	28.4	21.3	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2016	9.9	21.7	10.4	24.4	22.4	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2017	10.8	21.2	23.0	27.0	23.5	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2018	10.8	21.9	11.9	22.8	21.0	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2019	11.3	24.5	19.8	27.6	21.0	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2020	10.9	23.8	18.0	26.9	21.6	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
Total	10.9	22.6	15.4	26.9	21.8	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
p-value	0.379^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.	0.005^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.	0.032^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.	<0.001^* * Kruskal-Wallis; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.	–

Year	Adjusted MELD score for HCC			p-value
	20	24	29
	n (%)	n (%)	n (%)
2011	9 (5.9)	1 (0.9)	0 (0.0)	<0.001*
2012	15 (9.8)	4 (3.4)	0 (0.0)
2013	13 (8.5)	14 (12.1)	0 (0.0)
2014	6 (3.9)	17 (14.7)	5 (13.9)
2015	16 (10.5)	15 (12.9)	5 (13.9)
2016	20 (13.1)	9 (7.8)	2 (5.6)
2017	24 (15.7)	7 (6.0)	1 (2.8)
2018	25 (16.3)	19 (16.4)	1 (2.8)
2019	9 (5.9)	15 (12.9)	11 (30.6)
2020	16 (10.5)	15 (12.9)	11 (30.6)
Total	153 (100)	116 (100)	36 (100)

Year	Waiting time (days)			Total	p-value
Year	Adjusted MELD score for HCC	Other adjusted MELD score situations	No adjusted MELD score	Total	p-value
2011	267.0	–	298.1	291.4	0.917^ Mann-Whitney; HCC: hepatocellular carcinoma; MELD: Model of End-Stage Liver Disease.
2012	72.2	67.5	138.4	123.2	0.171^* * Kruskal-Wallis;
2013	105.2	101.2	116.9	113.0	0.404^* * Kruskal-Wallis;
2014	146.3	53.9	132.9	131.9	0.059^* * Kruskal-Wallis;
2015	146.3	260.6	146.1	155.2	0.101^* * Kruskal-Wallis;
2016	87.3	156.6	102.0	103.2	0.033^* * Kruskal-Wallis;
2017	70.9	64.3	69.7	69.8	0.002^* * Kruskal-Wallis;
2018	98.8	127.1	101.9	102.9	<0.001^* * Kruskal-Wallis;
2019	167.3	88.7	91.1	101.6	<0.001^* * Kruskal-Wallis;
2020	207.1	122.3	132.5	145.7	<0.001^* * Kruskal-Wallis;
Total	131.9	131.4	110.6	115.4	<0.001
p-value	<0.001^* * Kruskal-Wallis;	0.415^* * Kruskal-Wallis;	<0.001^* * Kruskal-Wallis;	<0.001^* * Kruskal-Wallis;	–

Year	Waiting time (days)			p-value
Year	Adjusted MELD of 20	Adjusted MELD of 24	Adjusted MELD of 29	p-value
2011	278.9	160.0	–	0.8^ Mann-Whitney; MELD: Model of End-Stage Liver Disease.
2012	54.9	137.0	–	0.147^ Mann-Whitney; MELD: Model of End-Stage Liver Disease.
2013	83.8	125.0	–	0.008^ Mann-Whitney; MELD: Model of End-Stage Liver Disease.
2014	63.3	129.8	304.2	<0.001^* * Kruskal-Wallis;
2015	67.3	139.0	421.4	<0.001^* * Kruskal-Wallis;
2016	47.2	137.1	310	<0.001^* * Kruskal-Wallis;
2017	72.8	66.4	57.0	0.997^* * Kruskal-Wallis;
2018	55.2	151.1	196.0	<0.001^* * Kruskal-Wallis;
2019	75.0	187.7	214.6	<0.001^* * Kruskal-Wallis;
2020	147.6	182.4	327.5	<0.001^* * Kruskal-Wallis;
p-value	0.006^* * Kruskal-Wallis;	0.036^* * Kruskal-Wallis;	0.035^* * Kruskal-Wallis;	–
Total	84.9	144.7	290.7	<0.001^* * Kruskal-Wallis;

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[1] Correspondence: Alexandre Coutinho Teixeira de Freitas. E-mail: alexandrefreitas@ufpr.br