Transplantation remains the standard of care for liver cancer patients, regardless of age

Transplantation remains the standard of care for liver cancer patients, regardless of age

Doctors and researchers at UK HealthCare's Transplant Center and the University of Kentucky Markey Cancer Center conducted a study of patients over the age of 70 with a type of liver cancer called hepatocellular carcinoma (HCC) and examined how the results of ablative treatments compare with liver transplants. The results were published in the May 2022 issue of the Journal of the American College of Surgeons.

Hepatocellular carcinoma is a cancer that begins in the liver, usually as part of cirrhosis, and if detected early enough, can be treated with various therapies. The optimal therapy for this early-stage HCC is a liver transplant. Unfortunately, the need for donated livers far exceeds the demand.

There are far more people in need of a liver transplant than there are organs available. Transplant physicians have struggled for years to determine the best use of a scarce resource.”

Malay Shah, MD, surgical director of the liver transplant program at UK HealthCare

Numerous factors are considered when considering a particular patient for a liver transplant. Surgical outcome data have shown that older patients have poorer overall outcomes compared to younger patients. This is partly due to pre-existing health problems in older patients. More specifically, transplants are invasive and complicated procedures that require extensive postoperative care and follow-up. The risk of complications is high, and older people are particularly vulnerable. As a result, fewer older patients with HCC are considered candidates for transplantation.

“Too often I hear from patients that I’m too old for a transplant,” Shah said. “This study shows that in selected patients, transplantation is an acceptable option that provides a significant survival benefit over ablation therapy alone.

Ablation is a minimally invasive procedure that kills or slows the growth of a tumor. If ablation can provide a similar survival benefit to transplantation in older patients with HCC, it could potentially be a better, less invasive treatment for them instead of transplantation. This would allow transplant centers to use scarce donor livers on other patients who have no other alternative to transplantation. Conversely, if older patients have good outcomes after transplantation compared to ablation therapy alone, they should still be considered for transplantation and age should not be a factor.

“HCC is one of the leading indications for liver transplantation, and many therapies are used to treat these cancers while the patient awaits a transplant,” Shah said. "Therapies such as ablation are performed to prevent disease progression while awaiting transplantation. The technology and effectiveness of these therapies have improved significantly in recent years."

During the study period, 214 patients aged 70 years or older with stage I or II HCC who received a liver transplant were identified and compared with 2,377 patients in the same age group who received ablation as target therapy.

“This was the first head-to-head comparison of liver transplant and non-transplant outcomes for HCC in elderly patients,” Shah said. "What we found is that patients over 70 years of age still had a very significant survival benefit from transplantation compared to ablative therapy alone and that transplantation should continue to be offered to eligible older patients. Liver transplantation remains the standard of care for patients with HCC, regardless of age."

Over 12,000 people in the United States are on the waiting list for a liver transplant. To reduce the organ shortage and give others a second chance at life, register as an organ donor today https://registermeky.org/.

Source:

University of Kentucky

Reference:

Shah, MB et al. (2022) Outcomes in elderly patients undergoing liver transplantation compared with liver-directed ablative therapy for early-stage hepatocellular carcinoma. Journal of the American College of Surgeons. doi.org/10.1097/XCS.0000000000000135.