What is the effect hepatocellular tumor down staging prior to liver transplant?
Investigator initiated In patients with cirrhosis, liver transplantation is indicated as a potentially curative therapy for patients with stage I and II hepatocellular carcinoma (HCC). Although initially controversial, multiple reports now demonstrate that five-year post transplant patient survival for cirrhotics with small tumors is similar to survival among patients undergoing transplant without cancer. Therefore, the transplant community as sanctioned by the United Network for Organ Sharing (UNOS) grants MELD (model for end stage liver disease) exception points to patients with small HCC in order to improve their status on the waiting list. However, patients with stage III and IV tumors have been found to have worse long term outcomes due to tumor recurrence. Reflective of the poorer outcomes, UNOS does not grant exception points to patients with tumors exceeding stage II. Most centers are reluctant to transplant patients with higher stage tumors due to poor outcomes, and doing so a
