Potential Role of Liver Transplantation for Child–Pugh Class A Hepatocellular Carcinoma: Prognosis and Medical Expenditure in Japan—A Retrospective Single‐Center Study
Akihiro Seki, Tomoyoshi Chiba, Shintaro Yagi, Rika Horii, Noboru Takata, Hiroki Nomura, Masaki Miyazawa, Tomoyuki Hayashi, Takeshi Terashima, Shinichi Nakanuma, Mitsuyoshi Okazaki, Satoshi Takada, Tatsuya Yamashita, Masao Honda, Hajime Takatori, Tetsuro Shimakami, Taro YamashitaABSTRACT
Aim
In Japan, liver transplantation (LT) for hepatocellular carcinoma (HCC) is restricted to patients with decompensated cirrhosis. We investigated the clinical course, prognosis, and medical expenditure of patients with Child–Pugh class A (CP‐A) HCC initially within the Japan criteria, including changes in oncological eligibility for LT during follow‐up.
Methods
We retrospectively analyzed patients with HCC treated at Kanazawa University Hospital between 2011 and 2021. After applying the age criterion (< 70 years), 134 patients with CP‐A HCC, 45 with CP‐B HCC, and 6 LT recipients were included. Survival and cumulative HCC‐related medical expenditures were compared. A transplantable period was defined as the interval during which both hepatic reserve and tumor burden met LT eligibility.
Results
LT achieved the most favorable prognosis, with a 5‐year overall survival rate of 83.3%. Among patients with CP‐A HCC, progression beyond the Japan criteria was associated with markedly reduced survival, approaching that observed in CP‐B disease. Of 53 patients who progressed beyond the Japan criteria, only 12 (22.6%) retained a transplantable period (median, 10.6 months). Early recurrence and a FIB‐4 index > 5 were independently associated with poor prognosis. The cost per treatment life‐year did not differ significantly between LT recipients and certain CP‐A HCC subgroups.
Conclusions
Many patients with CP‐A HCC initially within the Japan criteria lost oncological eligibility for LT before hepatic decompensation. Further studies are warranted to determine whether a subset of patients with compensated cirrhosis may benefit from LT and to inform future discussions regarding the potential expansion of LT indications.