Wait Time of < 6 and > 18 Months Predicts Hepatocellular Carcinoma Recurrence after Liver Transplantation: Proposing a Wait Time "Sweet Spot".

Background: It has been postulated that short wait time before liver transplant (LT) for hepatocellular carcinoma (HCC) results in the inclusion of tumors with aggressive biology, but prolonged wait time could result in a shift to more aggressive tumor behavior. We therefore test the hypothesis that a wait time "sweet spot" exists with a lower risk for HCC recurrence compared to the other 2 extremes. Methods: This multi-center study included 911 patients from 3 LT centers with short, medium and long wait times (median of 4, 7, and 13 months, respectively) who received MELD exception listing for HCC from 2002-2012. Results: Wait time, defined as time from initial HCC diagnosis to LT, was 18 months in 13.9%. Waitlist dropout was observed in 18.4% at a median of 11.3 months. Probability of HCC recurrence at 1 and 5 years were 6.4% and 15.5% with wait time 18 months (n=343) versus 4.5% and 9.8% with wait time of 6-18 months (n=397), respectively (p=0.049). When only pre-LT factors were considered, wait time 18 months (HR 1.6, p=0.043) and AFP >400 at HCC diagnosis (HR 3.0, p18 months) wait times and an increased risk for HCC recurrence post-LT. The so-called "sweet spot" of 6-18 months should be the target to minimize HCC recurrence. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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