Author/Authors :
Herden, Uta Department of Hepatobiliary and Transplant Surgery - University Medical Center Hamburg-Eppendorf, Hamburg, Germany , Schoening, Wenzel Department of General Visceral and Transplantation Surgery - University Hospital of RWTH, Aachen, Germany , Pratschke, Johann Department of Surgery - Campus Charite-Mitte and Campus Virchow-Klinikum, Berlin, Germany , Manekeller, Steffen Department of General Visceral Toracic and Vascular Surgery - University Hospital of Bonn, Germany , Paul, Andreas Department of General Visceral and Transplantation Surgery - University of Duisburg-Essen - University Hospital Essen, Germany , Linke, Richard Department of General and Visceral Surgery - Frankfurt University Hospital - Goethe-University Frankfurt/Main, Germany , Lorf, Thomas Department of General Visceral and Transplant Surgery - University Medical Center Gottingen, Germany , Lehner, Frank Department of General Visceral and Transplantation Surgery - Hannover Medical School, Germany , Braun, Felix Department of General Visceral Toracic Transplantation and Pediatric Surgery - University Medical Center Schleswig-Holstein, Kiel, Germany , Stippel, Dirk L Department of General Visceral and Cancer Surgery - University of Cologne, Koln, Germany , Sucher, Robert Department of Visceral Transplantation Vascular and Toracic Surgery - University Hospital of Leipzig, Germany , Schmidt, Hartmut Department of Transplantation Medicine - University Hospital Munster, Germany , Strassburg, Christian P 3Eurotransplant Liver Intestine Advisory Committee - Eurotransplant International Foundation, Leiden, Netherlands , Guba, Markus Eurotransplant Liver Intestine Advisory Committee - Eurotransplant International Foundation, Leiden, Netherlands , Rosmalen, Marieke van Eurotransplant Liver Intestine Advisory Committee - Eurotransplant International Foundation, Leiden, Netherlands , Rogiers, Xavier Eurotransplant Liver Intestine Advisory Committee - Eurotransplant International Foundation, Leiden, Netherlands , Samuel, Undine Eurotransplant International Foundation, Leiden, Netherlands , MSc Schön, Gerhard Department of Medical Biometry and Epidemiology - University Medical Center Hamburg-Eppendorf, Germany , Nashan, Bjoern Department of Hepatobiliary and Transplant Surgery - University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Abstract :
Selection and prioritization of patients with HCC for LT are based on pretransplant imaging diagnostic, taking the risk of incorrect diagnosis. According to the German waitlist guidelines, imaging has to be reported to the allocation organization (Eurotransplant) and pathology reports have to be submitted thereafter. In order to assess current procedures we performed a retrospective multicenter analysis in all German transplant centers with focus on accuracy of imaging diagnostic and tumor classification. 1168 primary LT for HCC were conducted between 2007 and 2013 in Germany. Patients inside the Milan, UCSF, and up-to-seven criteria were misclassified with definitive histologic results in 18%, 15%, and 11%, respectively. Patients pretransplant outside the Milan, UCSF, and up-to-seven criteria were otherwise misclassified in 34%, 43%, and 41%. Recurrence-free survival correlated with classification by posttransplant histological report, but not pretransplant imaging diagnostic. Univariate analysis revealed tumor size, vascular invasion, and grading as significant parameters for outcome, while tumor grading was the only parameter persisting by multivariate testing. Conclusion. There was a relevant percentage (15-40%) of patients misclassified by imaging diagnosis at a time prior to LI-RADS and guidelines to improve imaging of HCC. Outcome analysis showed a good correlation to histological, in contrast poor correlation to imaging diagnosis, suggesting an adjustment of the LT selection and prioritization criteria.
