Intent-to-Treat Analysis of Liver Transplant for Hepatocellular Carcinoma in the MELD Era: Impact of Hepatitis C and Advanced Status.

Background/Aim: Liver transplantation is a well-recognized treatment for non-resectable hepatocellular carcinoma (HCC); however, the overall survival and waiting list removal rates for hepatitis C virus (HCV)-related HCC have not been assessed. Methods: The present study included 11,146 patients with HCC and 64,788 patients without HCC, listed for liver transplantation on the Scientific Registry of Transplant Recipients database between 2003 and 2010. Results: In a multivariate analysis, HCV infection was an independent predictor of being transplanted or remaining on the waiting list in HCC candidates (HR 0.65, 95 % CI 0.60-0.71, p < 0.001). However, patients in the advanced status (model for end-stage liver disease score over 20, tumor stage exceed tumor-node-metastasis stage II, or alpha fetoprotein lover 400 ng/ml) but without HCV had better post-transplant survival than patients in the advanced status and with HCV (64 vs. 47 % at 5 years, p < 0.001), and comparable survival to patients with HCV but not in the advanced status (62 %, p = 0.461). Conclusions: HCC candidates with HCV infection are more likely to be transplanted, remain on the waiting list for longer, and have worse post-transplant survival. Patients in the advanced status but without HCV also could share a similar post-transplant survival to those not in the advanced status but with HCV. [ABSTRACT FROM AUTHOR]