Characterizing the risk of false-positive hepatocellular carcinoma in recipients transplanted with T2 MELD exceptions.

Background: Patients with hepatocellular carcinoma (HCC) can receive Model for End-Stage Liver Disease (MELD) exception points to increase waitlist priority for liver transplantation. This process does not require a biopsy and is based on radiologic criteria. However, imaging modalities are imperfect, and some will ultimately have no HCC on explant. Methods: This was a retrospective cohort study using national explant pathology data from 2012-2015. False-positive HCC was defined as answering "no" to the question: "was evidence of HCC (viable or non-viable) found in the explant?" in patients with T2 MELD exceptions. Results: 4,117 patients received T2 MELD exceptions, of which 245 (6%) had false-positive HCC. Maximal tumor diameter of 3-5cm and serum alfa fetoprotein (AFP) >100ng/mL at transplant yielded a 50% lower risk of false positive HCC (OR 0.45, 95% CI: 0.27-0.73 and OR 0.57, 95% CI: 0.37-0.88, respectively). Recipients with immune-mediated liver disease were twice as likely to have no HCC on explant (OR 2.12, 95% CI: 1.18-3.83) and had a predicted probability of false positive HCC >10% regardless of largest tumor size or AFP. Significant among-center variability in the rate of false-positive HCC was seen. Conclusions: The risk of false-positive HCC is markedly higher in certain groups, such that biopsy may be warranted prior to T2 MELD exception point approval. Transplant centers with high false-positive HCC rates may benefit from greater oversight. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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