To maximize utility and prevent premature liver transplantation (LT), a delayed LT strategy (DS) was adopted in France in 2015 in patients listed for any single HCC treated with resection or thermal ablation during the waiting phase. The DS involves postponing LT until recurrence. The purpose of this study was to evaluate the DS to make sure that it did not hamper pre- and post-LT outcomes. Patients listed for HCC in France between 2015 and 2018 were studied. After data extraction from the national LT database, 2,025 patients were identified and classified according to six groups: single tumor entering DS, single tumor not entering DS, multiple tumors, no curative treatment, untreatable HCC or T1 tumors. Kaplan-Meier estimates of the 18-month risk of dropout for death, too sick to be transplanted or tumor progression before LT, 5-year post-LT HCC recurrence and post-LT survival rates were compared. Median waiting-time in the DS group was 910 days. Pre-LT dropout probability was significantly lower in the DS group compared to other groups (13% . 19%, 0.0043) and significantly higher in the T1 group (25.4%, 0.05). Post-LT HCC recurrence rate in the multiple nodules group was significantly higher (19.6%, 0.019), while 5-year post-LT survival did not differ among groups and was 74% in the DS group ( 0.22). The DELTA-HCC study shows that DS does not negatively impact either pre- nor post-LT patient outcomes, and has the potential to allow for redistribution of organs to patients in more urgent need of LT. It can reasonably be proposed and pursued. The unexpectedly high risk of dropout in T1 patients seems related to the MELD-based offering rules underserving this subgroup. To maximize utility and prevent premature liver transplantation (LT), a delayed LT strategy was adopted in France in 2015. It involves postponing LT until recurrence in patients listed for any single HCC curatively treated by surgical resection or thermal ablation. The DELTA-HCC study was conducted to evaluate this nationwide strategy. It shows in a European LT program that delayed strategy does not negatively impact pre- nor post-LT patient outcomes and is relevant to up to 20% of LT candidates; thus, it could potentially enable the redistribution of organs to patients in more urgent need of LT. Such a delayed strategy can reasonably be pursued and extended to other LT programs. Of note, an unexpectedly high risk of dropout in T1 patients, seemingly related to MELD-based offering rules which underserve these patients, calls for further scrutinization and revision of allocation rules in this subgroup.

中文翻译：

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接受桥接治疗的 HCC 患者延迟肝移植策略的评估：DELTA-HCC 研究


为了最大限度地提高效用并防止过早肝移植 (LT)，法国于 2015 年对在等待阶段接受切除或热消融治疗的任何单一 HCC 患者采取了延迟 LT 策略 (DS)。 DS 涉及推迟 LT 直至复发。本研究的目的是评估 DS，以确保它不会妨碍 LT 前后的结果。对 2015 年至 2018 年间法国列出的 HCC 患者进行了研究。从国家LT数据库中提取数据后，识别出2025例患者，并根据六组进行分类：单个肿瘤进入DS、单个肿瘤未进入DS、多发肿瘤、无治愈性治疗、无法治疗的HCC或T1肿瘤。比较了 Kaplan-Meier 对 LT 前因死亡、病重而无法移植或肿瘤进展而退出的 18 个月风险、LT 后 5 年 HCC 复发和 LT 后生存率的估计。 DS 组的中位等待时间为 910 天。与其他组相比，DS 组的 LT 前脱落概率显着较低 (13% . 19%, 0.0043)，而 T1 组则显着较高 (25.4%, 0.05)。多结节组的 LT 后 HCC 复发率显着较高（19.6%，0.019），而 LT 后 5 年生存率在各组之间没有差异，DS 组为 74%（0.22）。 DELTA-HCC 研究表明，DS 不会对 LT 之前或之后的患者结局产生负面影响，并且有可能将器官重新分配给更迫切需要 LT 的患者。可以合理地提出并实行。 T1 患者的意外高辍学风险似乎与基于 MELD 的提供规则未能为该亚组提供服务有关。 为了最大限度地提高效用并防止过早肝移植 (LT)，法国于 2015 年采用了延迟 LT 策略。该策略包括推迟 LT，直至通过手术切除或热消融治愈的任何单一 HCC 患者出现复发为止。 DELTA-HCC 研究的目的是评估这一全国性战略。它在欧洲 LT 计划中表明，延迟策略不会对 LT 术前或术后患者的结果产生负面影响，并且与高达 20% 的 LT 候选者相关；因此，它有可能将器官重新分配给更迫切需要 LT 的患者。这种延迟策略可以合理地推行并扩展到其他 LT 计划。值得注意的是，T1 患者的退出风险出乎意料地高，这似乎与基于 MELD 的提供规则未能充分服务这些患者有关，因此需要进一步审查和修订该亚组的分配规则。