Kow, Krishnakumar Madhavan Purpose: Successful downstaging of hepatocellular carcinoma (HCC) into the Milan criteria (MC) remains a controversial indication for orthotopic liver transplantation (OLT). In Belgium, successful downstaging of HCC is an accepted non-standardized exception (NSE) for liver allocation. This NSE group
represents a unique cohort to analyse if OLT can be safely Lumacaftor offered to patients with those extended allocation criteria. The aim of this study is to compare the overall and recurrence free survival after cadaveric OLT between patients with successful downstaging (MILDOWN) and patients always inside the MC (MILIN) from all Belgian transplant centres. Methods: We retrospectively analysed all patients listed for OLT with HCC and underlying cirrhosis between 12/2006 and 12/2011 from all Belgian liver transplant centres.
Successful downstaging was defined as bringing a patient who was outside the MC into the MC after locoregional therapy (LRT). Results: Overall 381 patients were listed in Belgium during the study period. Of these, 320 received OLT. 248 were MILIN, 62 were MIL- DOWN and NVP-LDE225 manufacturer 10 were transplanted outside MC. Downstaging treatment included transarterial chemoembolization (TACE; n=26), radiofrequency (RF; n=9), transarterial radioembolisa-tion (TARE; n=4), resection (n=3), percutaneous ethanol injection (n=2) and a combination of the above-mentioned therapies in 18 cases. In the MILIN group 67.3% received locoregional therapy before transplantation, with no significant differences in the distribution of treatment type compared to the
MIL-DOWN group. At listing there were no significant differences between the MILIN and MILDOWN group for age, gender and underlying liver disease. Median time on waiting list between the two groups was similar (120 days vs. 115.5 days). Overall survival learn more at 1 year was not significantly different between MILIN and MILDOWN (87.1% vs. 79% p=0.120). 1.6% of patients were lost to follow-up in both groups. Although not significant, recurrence free survival at 1 year tended to be higher in the MILIN group than in the MILDOWN group (83.9% vs. 74.2%; p=0.073). Conclusion: In this large Belgian multicentre cohort, overall and recurrence free survival at 1 year are not significantly different between patients who have been downstaged successfully and patients who were always inside the Milan criteria. However, a longer follow up period will define, if the trend of lower survival in the successfully downstaged group becomes significant. Factors associated with HCC recurrence have to be identified. Disclosures: Jan P.