[O-25] PRE-TRANSPLANT IMAGING CORRELATE POORLY WITH EXPLANT PATHOLOGY IN LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA.

Ahmed Fahmy, Ivo Mitsiev, Vincent Peyregne, Thomas Diflo, Devon John, Glyn Morgan, Lewis Teperman Department of Transplantation, New York University Medical Center, New York, NY, USA

Accurate clinical staging is critical for proper allocation of deceased donor livers to ensure acceptable outcomes from OLT. The aim of this study was to establish the accuracy of preoperative imaging in staging HCC patients and define the correlation between pretransplant imaging and explant characteristics. We also looked at tumor characteristics associated with inaccurate staging.
Methods and Results: We analyzed data from all patients undergoing liver transplant for HCC at our center from 1/2003 to 11/2008. A total of 157 patients were transplanted with HCC. Only patients with an imaging study (MRI or CT) within 3 months of transplant were included. Data from 143 patients were analyzed. Recurrence rate was 10 % after a median follow up of 20.2 months. Patients were staged using the TNM staging classification of the American Liver Tumor Study Group and the Milan criteria. Eight patients (5.6%) had no tumor on explant and were considered overstaged, and 9 patients (6.3%) with HCC on pathology had no tumor on imaging studies; these were considered understaged. Accurate TNM staging was achieved in 74 patients (51.7%). Forty two patients (29.4%) were understaged by imaging studies and 27 patients (18.9%) were overstaged. This inaccurate staging affected the Milan status of 46 patients (32.2%). After excluding patients with incidental tumors and those with no tumor on explant, 20 patients (13.9%) were understaged and had tumors that exceeded Milan criteria on explant, and 9 patients (5.6%) were overstaged and would have wrongly been denied transplant. Patients who were understaged had a mean tumor diameter on imaging of 2.7cm, not different from those accurately staged, and a mean tumor number of 1.2, significantly less than those accurately staged (P=.043). Comparing the pathologic characteristics of the two groups; understaged patients had significantly larger tumors, with a mean diameter of 5.7cm, compared to 2.7 cm in those accurately staged (P< 0.001) and mean tumor number of 3.6, significantly more than those accurately staged (P< 0.001). Conclusion: Our data suggest that despite imaging every 3 months a significant percentage of patients are inaccurately staged with more being understaged than overstaged. If we wish to expand the transplant criteria for HCC, accurate staging must be achieved to avoid poor outcomes.

Date: Thursday, July 9, 2009
Session Info: Patient Selection/Organ Allocation (2:30 PM-4:00 PM)
Presentation Time: 2:30 PM
Room: Sutton Center, Level 2