Misdiagnosis of hepatocellular carcinoma in patients receiving no local-regional therapy prior to liver transplant: An analysis of the Organ Procurement and Transplantation Network explant pathology form.

Publisher: Munksgaard Country of Publication: Denmark NLM ID: 8710240 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-0012 (Electronic) Linking ISSN: 09020063 NLM ISO Abbreviation: Clin Transplant Subsets: MEDLINE

Original Publication: Copenhagen : Munksgaard,

Diagnostic Errors* ; Patient Selection*; Carcinoma, Hepatocellular/*surgery ; Health Care Rationing/*standards ; Liver Neoplasms/*surgery ; Liver Transplantation/*mortality ; Tissue and Organ Procurement/*standards; Adult ; Carcinoma, Hepatocellular/diagnosis ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/diagnosis ; Male ; Middle Aged ; Prognosis ; Survival Rate ; Waiting Lists

Patients with T1 hepatocellular carcinoma (HCC) are not eligible for Model for End Stage Liver Disease (MELD) exception for liver transplant (LT) in part due to a high rate of misdiagnosis (no HCC on explant). The likelihood of misdiagnosis for T2 HCC and factors associated with misdiagnosis are unknown. We analyzed the Organ Procurement and Transplantation Network database including 5664 adults who underwent LT from 2012 to 2015 with MELD exception for T2 HCC, and searched for no evidence of HCC in the explant pathology file. We focused on those (n = 324) receiving no local-regional therapy (LRT) to evaluate the probability of no HCC found in explant. Median waiting time was short at 1.7 months, and 35 (11%) had no HCC on explant. On multivariable logistic regression, factors associated with no HCC on explant were age <50 (OR: 17.3, P < .001), non-HCV (OR: 5.4, P = .001), and alpha-fetoprotein <10 (OR: 2.9, P = .04). Tumor size and number were not different between groups. The proportion of misdiagnosis did not change significantly after implementation of Liver Imaging Reporting and Data System (LI-RADS) for HCC diagnosis.
Conclusion: The rate of misdiagnosis was 11% among T2 HCC patients who underwent LT without receiving LRT prior to LT and did not change significantly after implementation of LI-RADS. More efforts are needed to eliminate unnecessary LT for patients without HCC.
(© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Hepatology. 2011 Mar;53(3):1020-2. (PMID: 21374666)
Cancer. 2014 Nov 15;120(22):3485-93. (PMID: 25042049)
Hepatology. 2008 Jan;47(1):97-104. (PMID: 18069697)
Liver Transpl. 2016 Feb;22(2):178-87. (PMID: 26479422)
Hepatology. 2014 Dec;60(6):1957-62. (PMID: 24954365)
Liver Transpl. 2004 Jan;10(1):42-8. (PMID: 14755776)
Liver Transpl. 2002 Dec;8(12):1156-64. (PMID: 12474156)
J Magn Reson Imaging. 2007 Dec;26(6):1548-55. (PMID: 17968956)
Liver Transpl. 2003 Jul;9(7):684-92. (PMID: 12827553)
J Hepatol. 2013 Feb;58(2):312-8. (PMID: 23069476)
Lancet Oncol. 2012 Jan;13(1):e11-22. (PMID: 22047762)
Clin Transplant. 2015 Jan;29(1):52-9. (PMID: 25366656)
Liver Transpl. 2006 Oct;12 (10 ):1504-11. (PMID: 16952174)
N Engl J Med. 1996 Mar 14;334(11):693-9. (PMID: 8594428)
Liver Transpl. 2016 Jun;22(6):757-64. (PMID: 26970341)
Hepatology. 2015 May;61(5):1643-50. (PMID: 25644186)
Radiology. 2013 Feb;266(2):376-82. (PMID: 23362092)
N Engl J Med. 2011 Sep 22;365(12):1118-27. (PMID: 21992124)
AJR Am J Roentgenol. 2016 Jul 19;:1-7. (PMID: 27440522)
J Hepatol. 2012 Apr;56(4):908-43. (PMID: 22424438)
Stat Med. 1998 Jan 15;17(1):59-68. (PMID: 9463849)
Hepatology. 2015 Mar;61(3):1056-65. (PMID: 25041904)

P30 DK026743 United States DK NIDDK NIH HHS

Keywords: Liver Imaging Reporting and Data System; Organ Procurement and Transplantation Network; United Network for Organ Sharing; alpha-fetoprotein

Date Created: 20170908 Date Completed: 20180627 Latest Revision: 20181113

20231215

PMC5937711

10.1111/ctr.13107

28881064