Liver Transplant & HCC

Question 1

What are leading causes of OLT?

Answer 1

HCV (33%)
Cholestatic disease (14%)
Alcohol (12%)
NASH (9%)
HCC (6%)

Question 2

Why do people go on transplant list?

Answer 2

Decompensated cirrhosis:
Variceal bleed (15-20% 30-day mortality)
Ascites: 56% 5yr survival
Hepatorenal syndrome
HE

HCC

Question 3

What are the categories in the CTP score? (5)

Describe the scores for A/B/C

Answer 3

Bilirubin, albumin, INR, ascites, encephaopathy

A: score of 5-6 for compensated cirrhosis
B: score of 7-9 for decompensated
C: score of 10-15 decompensated

Question 4

What is status 1A in CTP score?

Answer 4

Acute liver failure
Acute wilson’s disease
Immediate post-transplant complications (non-function; hepatic artery thrombosis)

Question 5

What is a MELD score?

Answer 5

Predicts 3-month survival based on serum creatinine, BR, INR

Question 6

What is a MELD exception point?

Answer 6

An approximated additional MELD score based on certain parameters (i.e 15% 3-month mortality=22MELD pts)

Every 3 months=10% increase in mortality risk

Question 7

What are the diseases with MELD exception points? (6)

Answer 7

HCC
Hepatopulmonary syndrome
CF
Amyloid
Primary hyperoxaluria 
Cholangiocarcinoma

Question 8

What is benefit of living donor liver transplant?

Answer 8

Lower likelihood of death on waiting list– outcomes after transplant are similar for both living and cadaveric transplant

Question 9

What is rate of complications among donors? What is rate of death?

Answer 9

40% donors have complications

3/740 died

Question 10

How much of HCC occurs in cirrhosis context?

Answer 10

80-90% of HCC cases occur in cirrhosis

Question 11

What is aflatoxin and how is it related to HCC?

Answer 11

Aflatoxin is a toxin of aspergillum that grows on peanuts/corn and causes of mutation in p53

It has a synergistic cancer risk with HBV (relative risk=60)

Question 12

How does HCC present?

Answer 12

HCC is usually asymptomatic until it has spread ….it can present as worsening liver dysfunction

Question 13

How is HCC diagnosed?

Answer 13

Blood flow shifts from portal vein to hepatic artery (the shift mirrors increasing dysplasia)

Arterial phase CT: enhancing nodules
Portal venous phase: shows capsular enhancement

Question 14

Describe prognosis for HCC

Answer 14

Median survival

Question 15

What are the treatments for HCC?

Think both curative (3) and palliative (3)

Answer 15

Curative: OLT, liver resection, radiofrequency ablation
Palliative: chemoembolization, radiotherapy (radioembolization), chemotherapy

Question 16

What is criteria for OLT?

Answer 16

1 lesion

Question 17

What is the only chemotherapy pill approved for HCC?

How long does it prolong survival?

Answer 17

Sorafenib– a multikinase inhibitor that targets VEGF and Raf kinases

Prolongs survival by ~3 months