385 DO TUMOR CHARACTERISTICS AND LOCOREGIONAL THERAPY PREDICT SURVIVAL AFTER OLT IN PATIENTS WITH PRIMARY LIVER MALIGNANCY (HCC)?

Background: HCC prognosis after OLT is associated with criteria related to number and size (Milan and UCSF).However, degree of differentiation and efficacy of locoregional therapies may also influence outcome.AIM: Characterize patients with and without HCC and compare outcomes according to tumor characteristics.Methods: Retrospective query of an electronic medical record for the last 328 patients transplanted at CPMC in 2001-2007.HCC was defined by pre-OLT listing data as well as finding of a tumor consistent with HCC at explant.Milan and UCSF criteria were applied to the lesions as described by pathology upon explant exam.Results: 328 patients were evaluated, with 109 liver malignancies.103 females (26 (25%) HCC) and 225 males (83 (37%) HCC p = 0.04).Donor age and cold ischemia time were similar in the 2 groups.Survival was shorter in HCC (mean 984±599 days; median 357) vs. non HCC (1103±642; median 364) but NS (p = 0.10).Kaplan-Meier survivals were superposable (3 yr survival ~83%) when comparing patients with or without malignancy and when patients with low ( 22) vs. high MELD (>22) were compared.Survival curves in patients that fulfilled Milan vs. UCSF criteria were identical.However, more patients outside Milan died of metastatic disease (5/6, 83%) vs. within Milan (6/14, 43%, p = 0.01).Cox proportional hazards regression showed that MELD, but not malignancy, differentiation or necrosis, was associated with mortality; HR = 6% (95% C.I. 1-10%) per additional MELD point (p = 0.02).69 pts had TACE pre-OLT, 17 had RFA ± any other modality.There was no difference in survival in pts who received any locoregional therapy vs. those who did not (p = 0.5).Deaths occurred in 20 (18%) HCC vs. 43 (19%) non HCC pts.Causes of mortality were different: of 20 HCC patients, 11 (55%) died of HCC/metastatic disease vs. 2 (5%) in 41 non HCC deaths (p < 0.0001). Conclusion:In our cohort, survival of HCC patients was comparable to non HCC patients.However, mortality from metastatic disease was higher, particularly in those outside Milan.Overall mortality was associated with higher MELD scores, but not with tumor necrosis, degree of differentiation at explant or locoregional therapy.