13 April 2018, Paris, France: Patients with hepatocellular carcinoma (HCC) waiting for a liver transplant in the USA are now significantly less likely to receive a new liver than they were around a decade ago. A nationwide study presented today at The International Liver Congress™ 2018 in Paris, France, has confirmed that patients with HCC on the liver transplant list in the USA were more than 50% less likely to receive a transplant in 2014-2016 than they were in 2005-2007. Patients with Medicaid insurance were also significantly less likely to undergo liver transplantation than those with private/commercial insurance. 'This is a very worrying trend and reflects the continued imbalance between the number of patients with HCC in need of liver transplantation and the limited number of donor livers available', said Dr Jennifer Wang from the California Pacific Medical Center, San Francisco, USA, who presented the study findings today.
Hepatocellular carcinoma is the most common primary tumour of the liver, with average survival estimated to be 18 months.1,2 Liver transplantation is a guideline-recommended treatment for people with HCC,3 although individuals must meet strict criteria in order to join the waiting list.1,3 A recent study has shown that HCC is the most common indication for liver transplantation and placement on the waiting list in the USA.4 However, limited organ availability and an increasing demand has extended transplant waiting times, and increased morbidity and mortality amongst those listed.3
The study presented today was undertaken to evaluate overall trends in the probability of receiving a liver transplant among US adults with HCC on the transplant list. Data from the United Network for Organ Sharing Liver Transplant Registry were analyzed by year of listing (2005-2007, 2008-2010, 2011-2013, and 2014-2016), and stratified by age and insurance type. When stratified by age, the probability of receiving a liver transplant within 1 year of listing was highest amongst HCC patients aged 50-59 years (64.6%) and lowest amongst those aged 60-69 years (58.1%) (p<0.01). When stratified by insurance type, the probability of receiving a liver transplant within 1 year was highest amongst those with private/commercial insurance (63.6%) and lowest amongst those with Medicare insurance (52.8%) (p<0.001). In 2005-2007, the probability of receiving a liver transplant in the first year of joining the waiting list was 81.5% compared with just 51.7% in 2014-2016 (p<0.001). A multivariate regression analysis confirmed that HCC patients who joined the liver transplant waiting list in 2014-2016 were significantly less likely to receive a transplant than those who joined the list in 2005-2007 (HR 0.43; 95% CI 0.40, 0.46; p<0.001).'This means that, despite the increasing numbers of adults with HCC waiting for a liver transplant in the USA, patients are now 57% less likely to receive one than they were in the mid-2000s', said Dr Wang.
As well as the lack of donor livers, Dr Wang believes that the findings from her study also reflect disparities in the rates of liver transplantation amongst HCC patients - especially patients from ethnic minority backgrounds and those with Medicaid-type insurance. She also believes that the increasing burden of non-alcoholic fatty liver disease as a cause of HCC and the increasing numbers of patients with early-stage HCC that are eligible for liver transplantation have contributed to the current situation.
'Ultimately, this situation will only improve when newer therapies and more curative options for HCC become available', said Dr Wang. 'In the meantime, we need more research to help us understand the disparities identified in our study so that targeted interventions can be developed to ensure more equitable access to liver transplantation for all our HCC patients'.
'This increase in the proportion of patients who are potential candidates for liver transplantation will be associated with an irremediable increase in the waiting time and of the drop-out due to tumour progression', said Prof. Alejandro Forner from the Hospital Clinic Barcelona, Spain, and EASL Governing Board Member. 'Efforts should be directed to design prioritising strategies to facilitate access to liver transplantation for patients affected by HCC, without harming the patients listed due to impaired liver function'.
About The International Liver Congress™
This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2018 will take place from 11¬-15 April 2018 at the Paris Convention Centre, Paris, France.
About The European Association for the Study of the Liver (EASL)
Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.
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Onsite location reference
Session title: Liver tumours: Clinical aspects except therapy
Time, date and location of session: 13. April 2018, 09:00 AM - 05:00 PM
Presenter: Jennifer Wang, USA
Abstract: While hepatocellular carcinoma (HCC) has become the leading indication for liver transplantation in the United States, the probability of receiving liver transplantation among adults with HCC has rapidly declined (1128)
Jennifer Wang: None reported.
Robert Gish: Dr. Gish has received Grants/Research Support from AbbVie, Benitec Biopharma, Gilead Sciences, and Merck & Co. Dr. Gish has performed as Consultant and/or Advisor to AbbVie, Akshaya Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Genentech, Gilead Sciences, Hoffman-LaRoche, Ltd., Ionis Pharmaceuticals, Janssen, Merck & Co., Nanogen Biopharmaceutical, and Presidio Pharmaceuticals. Dr. Gish has current activity with the scientific or clinical advisory boards of AbbVie, AstraZeneca, Genentech, Gilead Sciences, Janssen, Merck & Co., and Nanogen Biopharmaceutical. Dr. Gish is a member of the Speakers Bureau for AbbVie, Bristol-Myers Squibb, Gilead Sciences, and Merck. Dr. Gish is a minor stock shareholder of Cocrystal Pharma.
Benny Liu: None reported.
Taft Bhuket: None reported.
Robert Wong: Dr. Wong receives research funding from Gilead Sciences and Abbvie, has served as a consultant and member of the advisory board for Gilead Sciences, and serves on the speaker's bureau for Gilead Sciences, Salix, and Bayer. Dr. Wong is also funded by an AASLD Foundational Clinical and Translational Research Award in Liver Diseases.
1. Byam J, et al. Liver transplantation for hepatocellular carcinoma. Hepatobiliary Surg Nutr. 2013;2(1):22-30.
2. Maluccio M, et al. Survival in patients with hepatocellular carcinoma (HCC): A report of 1444 patients treated within a multidisciplinary program. J Clin Oncol. 2017;35(15_suppl):e15652.
3. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2016;64(2):433-85.
4. Yang JD, et al. Hepatocellular carcinoma is the most common indication for liver transplantation and placement on the waitlist in the United States. Clin Gastroenterol Hepatol. 2017;15(5):767-75.e3. ?