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Poster Sessions: Liver
The World Transplant Congress 2014 Abstract Supplement is jointly published by the American Journal of Transplantation and Transplantation on behalf of the American Society of Transplant Surgeons, The Transplantation Society and the American Society of Transplantation. © The Authors. Compilation © The American Society of Transplant Surgeons, The Transplantation Society and the American Society of Transplantation
All presenters are required to disclose relevant conflicts of interest. All such disclosures are published within the Abstract Book following each abstract. Any presenters who have nothing to disclose have been omitted from the disclosure listing.
Liver: Hepatocellular Carcinoma and Cholangiocarcinoma Malignancies Sunday, July 27, 2014 6:30 PM - 8:00 PM Exhibit Hall
time. Allocation policies that prolong waiting-list time for HCC candidates may not impact post-LT survival.
Abstract# A376 Everolimus Impact On Hepatocellular Carcinoma Recurrence After Liver Transplantation – 12, 24, and 36 Months Data From 719 Liver Transplant Recipients. G. Junge, F. Saliba, P. De Simone, L. Fischer, G. Dong, A. Speziale, J. Fung. H2304 Study Group, Basel, Switzerland.
Abstract# A374 Long-Term Outcome of Salvage Liver Transplantation for Hepatocellular Carcinoma Recurrence After Liver Resection. M. Del Gaudio, M. Cescon, G. Ercolani, A. Balduzzi, M. Ravaioli, A. Cucchetti, V. Bertuzzo, C. Zanfi, M. Morelli, A. Pinna. Liver and Multiorgan Transplantation Unit Prof. A.D. Pinna, S. Orsola Hospital - University of Bologna, Bologna, Italy.
Background: For patients with localized hepatocellular carcinoma (HCC) who don’t qualify for surgical resection, liver transplantation (LTx) is an appropriate treatment strategy. However, immunosuppression to reduce the incidence of acute rejection is associated with higher tumor recurrence, and efforts have been underway to reduce doses and to evaluate new treatment options to reduce this risk. Everolimus (EVR), a mammalian target of rapamycin inhibitor (mTORi), being approved as an antineoplastic agent in settings other than Tx and evidence derived from pre-clinical, retrospective and cohort studies suggests a protective role of EVR on recurrence of HCC after LTx. Data from prospective, randomized studies is still awaited. Here, we present HCC recurrence, patient outcome and impact of EVR treatment and exposure in 203 HCC patients at 12, 24, and 36 months (M) after LTx. Methods: Data were retrieved from study H2304 (NCT00622869) and its extension, a 3-year randomized controlled trial in 719 de novo LTx recipients comparing EVR (C0 3-8 ng/mL) plus reduced tacrolimus (rTAC, C0 3-5 ng/mL) or EVR (C0 6-10 ng/mL) with TAC withdrawal (TAC-WD) at M4 to standard TAC (TAC-C, C0 6-10 ng/mL). Milan criteria, number of tumor lesions, diameter of largest nodule, and total tumor diameter (TDD) as well as alpha fetoprotein (AFP) levels were assessed at time of Tx. Follow-up reporting was obtained at 12, 24, and at 36M for patients entering into the extension phase. Results: Baseline demographics and HCC characteristics were comparable (Table 1). Overall, HCC recurrence was observed in 2, 12, and 14 patients at M12, 24, and 36, respectively. Although not powered to show a difference in the HCC recurrence within three regimens, HCC recurrence was slightly lower in patients treated with EVR compared to TAC (4.2 vs 5.0%) at the end of the 24M core study. At M36, one patient each in EVR+rTAC and TAC-C arm reported HCC since extension baseline. Detailed data on patient outcome and risk factor analyses will be presented. Conclusion: EVR may offer an alternative immunosuppressive agent with intriguing prospects in patients transplanted for HCC.
Background: Liver resection (LR) first and liver transplantation (LT) as salvage therapy after LR for hepatocellular carcinoma (HCC) on cirrhosis is still debated. Methods: Between January 1996 and July 2013 1300 HCC patients were referred to our Center: 635 were listed for LT, 368 was treated by primary LT (PLT) and 45 by salvage LT (SLT). The remaining 665 were submitted to LR and 233 (35%) of these were transplantable at the time of LR. Considering PLT vs SLT patients, no differences resulted in terms of gender, age, MELD score and ethiology of cirrhosis. Preoperative TACE was performed in 44.8% vs 40.9% (p=NS), RFA in 12.7% vs 36.4% (p=0.002) and combined TACE/RFA in 8.2% vs 18.2% (p=0.003) in PLT and SLT group, respectively. HCC G3 was present in 57.3% vs 50% and G4 in 2.8% vs 10.2% in PLT vs SLT group, respectively (p=0.007). Results: Post-operative mortality was 0% vs 3.3% in SLT vs PLT group (p=NS). No differences were observed in terms of median time on waiting list (202 days vs 304 days), intraoperative red blood cells infusion (1850 vs 1500 cc), HCC recurrence (12% vs 15.5%) in PLT vs SLT group, respectively (p=NS). Five-year intention to treat survival of HCC listed patients vs LR transplantable patients was 58% vs 70% (p=NS). Overall survival at 1-, 3- 5- and 10-years was 87.3%, 78% , 71.7%, 69% vs 85.9%, 78.5%, 78.5%, 68.9% for PLT vs SLT group, respectively (p=NS). Disease-free survival at 1-, 3-, and 5-years was 85.5%, 75.4%, 70.8%, 65.7% vs 77%, 73.8%, 73.8%, 65% for PLT vs SLT group, respectively (p=NS). Conclusion: LR should be the first-line treatment in patients with small HCC and compensated cirrhosis, with salvage LT offered at the time of HCC recurrence or liver decompensation as a safe and effective approach.
Abstract# A375 Prolonged Waiting-List Time Does Not Have a Negative Impact in the Post-Transplant Survival of Patients With Hepatocellular Carcinoma. P. Salvalaggio, G. Felga, B. Della Guardia, M. Almeida, M. Rezende, P. Salvalaggio. Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
DISCLOSURES: Junge, G.: Employee, Novartis. Saliba, F.: Grant/Research Support, Novartis, Astellas, Roche and Gambro, Speaker’s Bureau, Schering Plough, MSD and Gambro, Other, Novartis, Astellas, Roche, Genzyme, Viropharma, Advisory Committee or Review Panels, Vital Therapies, Advisory Committee or Review Panels. De Simone, P.: Speaker’s Bureau, Novartis. Fischer, L.: Grant/ Research Support, Novartis and Astellas, Speaker’s Bureau, Gilead Sciences, Other, Novartis, Advisory Committee. Dong, G.: Employee, Novartis. Speziale, A.: Employee, Novartis. Fung, J.: Speaker’s Bureau, GSK, Other, BMS, Advisory Committee, Vital Therapies, Consultant.
NTRODUCTION: The amount of time that patients with hepatocellular carcinoma (HCC) within the Milan criteria (MC) can safely remain on the waiting list for liver transplantation (LT) is unknown. AIM: We investigated whether a long waiting list (>6-months) impacts the posttransplant survival of HCC recipients. METHODS: This is a single-center retrospective study of adults with HCC within the MC, who were treated with TACE while on the waiting for a deceased donor LT. Patients were divided in groups according to waiting-list time (9-months). The main endpoint was post-LT survival. RESULTS: 292 patients were selected as potential candidates and were listed for LT. A total of 187 patients underwent LT and met the eligibility criteria of the study. The median waiting time for LT for the entire cohort was 256 days (51-415 days). Mean follow-up after LT of the entire cohort of study was 2.2 years. There was a preponderance of white, middle-aged males with HCV with a biological MELD score of 13±5.2. Donors were usually middle-aged men, who died of cerebrovascular accident, and were transplanted at an average of 8.6±2 hours of cold ischemia. The average DRI was 1.6±0.3. Other donor and transplant characteristics were equivalent for all groups of the study. The dropout rate of the study cohort at 3, 6, and 12-months were 5.8%, 12.3%, and 16.1%, respectively. Post-LT survival did not differ based on the time on the waiting-list. Within the subgroup of patients with the longest waiting-list time, MELD score at transplant considerably influenced post-transplant survival, while alphafetoprotein level, tumor size, and response to TACE did not. Univariate and multivariate analysis failed to identify risk factors for worse survival on the subgroup of patients with long waiting-list time. The biological MELD was the only factor that independently impacted post-transplant survival in our multivariate analysis (p
