Liver allocation for hepatocellular carcinoma: A European center policy in the pre-MELD era

Background. Policies to decrease dropout during waiting time for liver transplantation (LT) are under debate. Methods. We evaluated the allocation system from 1996 to 2003, when recipients had priority related to Child-Pugh score and donors > 60 years were mainly offered to recipients with hepatocellular carcinoma (HCC). The outcomes of 656 patients with chronic liver disease (142 HCC and 514 non-HCC) listed for LT were prospectively evaluated, considering recipient and donor features. Results. Transplantation and dropout rates were similar between HCC and non-HCC patients: 64.1% vs. 70.6% and 26% vs. 22.6%. Multivariate analysis showed the probability of being transplanted within 3 months was related to Child-Pugh score > 10 and to HCC, whereas the probability of being removed from the list within 3 months was only related to Child-Pugh score > 10. HCC patients had a lower median waiting time (97 vs. 197 days, P < 0.001), a higher rate of donors > 60 years (50.5% vs. 33.5%, P < 0.005) and with steatosis (31.6% vs. 14.3%, P < 0.01), but a lower Child-Pugh score (9.1 +/- 2.1 vs. 9.6 +/- 1.7, P < 0.05) than non-HCC patients. The 5-year patient survival was comparable since registration on the list and since LT: 56.9% and 77% in the HCC group vs. 61.4% and 79% in the non-HCC patients. Donors > 60 years affected outcome after LT in the non-HCC group, but not in the HCC patients. Conclusion. By allocating donors > 60 years mainly to HCC patients, we controlled dropout without affecting their survival and the Outcome of non-HCC patients.