Wiesner RH, Freeman RB, Mulligan DC.
William J. von Liebig Transplant Center, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota 55905, USA. rwiesner@mayo.edu
Recent reports suggest that
selected patients undergoing liver transplantation for stage 1-2 hepatocellular
cancer (HCC) have an excellent long-term survival and a low incidence of recurrence.
In the past, over 45% of HCC patients on the United Network for Organ Sharing/Organ
Procurement Transplantation Network waiting list did not receive a donor organ
for up to 2 years. This resulted in not only a high mortality rate but a high
rate of being removed from the waiting list because of progression of HCC to
advanced stages. The introduction of the Model for End-Stage Liver Disease (MELD)
allocation policy has had a positive effect on HCC liver transplant candidates
with the number of patients transplanted for HCC significantly increasing over
the past several years. In addition, waiting time for HCC patients to receive
a deceased donor has decreased significantly and the number of patients dropping
out from the waiting list because of advanced stage disease has also decreased.
An early assessment of the MELD allocation policy suggests that posttransplant
survival for HCC patients comparing pre-MELD to post-MELD eras is similar. Using
the data we have collected on the MELD allocation policy, we have already made
modifications to the MELD allocation policy for HCC patients. It is hoped that
through continued data collection and assessment, a consensus can be reached
to further optimize the use of deceased donors in HCC recipients.
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