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

Abstract

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.