A novel model measuring the harm of transplanting hepatocellular carcinoma exceeding Milan criteria

M. L. Volk, S. Vijan, J. A. Marrero

Research output: Contribution to journalArticlepeer-review

129 Scopus citations

Abstract

No empirical studies have defined the posttransplant survival that would justify expansion of the Milan criteria for liver transplantation of hepatocellular carcinoma. We created a Markov model comparing the survival benefit of transplantation for a patient with >Milan HCC, versus the harm caused to other patients on the waiting list. In the base-case analysis, the strategy of transplanting the patient with >Milan HCC resulted in a 44% increased risk of death and a utility loss of 3 quality-adjusted years of life across the pre- and posttransplant periods for a nationally representative cohort of patients on the waiting list. This harm outweighed the benefit of transplantation for a patient with >Milan HCC having a 5-year posttransplant survival of less than 61%. This survival threshold was most sensitive to geographic variations in organ shortage, with the threshold varying from 25% (Region 3) to >72% (Regions 1, 5, 7 and 9). In conclusion, expansion of the Milan criteria will require demonstrating high survival rates for the newly eligible patients - approximately 61% at 5 years after transplantation. In regions with less severe organ shortage, a more aggressive approach to transplanting these patients may be justified.

Original languageEnglish (US)
Pages (from-to)839-846
Number of pages8
JournalAmerican Journal of Transplantation
Volume8
Issue number4
DOIs
StatePublished - Apr 2008

Keywords

  • Ethics
  • Hepatocellular carcinoma
  • Liver transplantation
  • Public policy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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