P-90 COMPARISON BETWEEN MILAN CRITERIA, FRENCH ALPHA-FETOPROTEIN MODEL, AND METROTICKET 2.0 FOR LIVER TRANSPLANTATION IN PATIENTS WITH HEPATOCELLULAR CARCINOMA.

Conflict of interest

No

Introduction and Objectives

Milan criteria (MC) have been the standard for selecting candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC). New strategies including alpha-fetoprotein with tumor number and diameter, such as the French alpha-fetoprotein model (FM) and Metroticket2.0 (MT), improve prediction of recurrence and prognosis. Objectives:

To compare these three tools in terms of survival and tumor recurrence.

Patients / Materials and Methods

A cohort study of 79 LT patients with HCC (2006-2020). Patients were divided by MC: within (WMC) and outside (OMC). They were reclassified using FM into low risk (LRFM) and high risk (HRFM), and with Metroticket2.0: ≥75% 5 year survival (MT≥75) and <75% (MT<75). Clinical, histological characteristics and 5-year survival were analyzed.

Results and Discussion

Follow-up was 100% with a median of 65.7 months. 86% received therapy before LT. Median age was 62 years. Overall survival (OS) was 57%, and 7 (9%) patients had recurrence at an average of 10.2 months post-transplant. (range: (5.7-14.8);(2.1 - 38.9)). All recurrences resulted in death. In the WMC cohort (n=67), OS was 66.5 months, with 4 (6%) recurrences. In the OMC cohort (n=12), OS was 58.3 months, with 3 (25%) recurrences. For FM, LRFM patients (n=70) had an OS of 66.2 months, with 4 (6%) recurrences, while HRFM (n=9) had an OS of 41.8 months, with 3 (33%) recurrences. With MT, MT≥75 (n=70) had an OS of 66.9 months, with 4 (6%) recurrences, and MT<75 (n=9) had an OS of 41.8 months, with 3 (33%) recurrences.

Conclusions

LT in HCC has had a 5-year OS above 70% and a recurrence rate of 8%. There is a significant difference in 5-year survival and recurrence for OMC patients, and also with HRFM and MT<75 criteria.