Potential Role of Liver Transplantation for Child-Pugh Class A Hepatocellular Carcinoma: Prognosis and Medical Expenditure in Japan-A Retrospective Single-Center Study.
AI interpretation is pending for this paper.
Open original publication →What the AI sees
Not AI summarized yet.
Research significance
Pending deeper interpretation.
Source abstract
AIM: In Japan, liver transplantation (LT) for hepatocellular carcinoma (HCC) is restricted to patients with decompensated cirrhosis. We investigated the clinical course, prognosis, and medical expenditure of patients with Child-Pugh class A (CP-A) HCC initially within the Japan criteria, including changes in oncological eligibility for LT during follow-up. METHODS: We retrospectively analyzed patients with HCC treated at Kanazawa University Hospital between 2011 and 2021. After applying the age criterion (< 70 years), 134 patients with CP-A HCC, 45 with CP-B HCC, and 6 LT recipients were included. Survival and cumulative HCC-related medical expenditures were compared. A transplantable period was defined as the interval during which both hepatic reserve and tumor burden met LT eligibility. RESULTS: LT achieved the most favorable prognosis, with a 5-year overall survival rate of 83.3%. Among patients with CP-A HCC, progression beyond the Japan criteria was associated with markedly reduced survival, approaching that observed in CP-B disease. Of 53 patients who progressed beyond the Japan criteria, only 12 (22.6%) retained a transplantable period (median, 10.6 months). Early recurrence and a FIB-4 index > 5 were independently associated with poor prognosis. The cost per treatment life-year did not differ significantly between LT recipients and certain CP-A HCC subgroups. CONCLUSIONS: Many patients with CP-A HCC initially within the Japan criteria lost oncological eligibility for LT before hepatic decompensation. Further studies are warranted to determine whether a subset of patients with compensated cirrhosis may benefit from LT and to inform future discussions regarding the potential expansion of LT indications.