Recurrent HCC
Initial Max Last
calculator
about
Unlike current allocation policy that only uses HCC burden at one time point, the RH-IML calculator uses a summative measure of pre-liver transplant HCC burden that incorporates tumor behavior and treatment response to predict the risk of post-liver transplant recurrent HCC.
publication
Vutien P, Dodge J, Bambha KM, Nordstrom EM, Gralla J, Campbell K, Levek C, Nydam T, Fix O, Ioannou G, Biggins SW. A simple measure of hepatocellular carcinoma burden predicts tumor recurrence after liver transplantation: The RH-IML classification. Accepted for publication in Liver Transplantation.
the data
Using UNOS data from 2002-2014, 16,558 liver transplant recipients with HCC (any stage) were assessed for HCC size (total diameter), pre-liver transplant treatment and post-liver transplant recurrent HCC.
HCC was measured at 3 dates on the waitlist: (I) Initial, (M) Max, (L) Last. Tumor burden at each date was classified as:
- < Milan
- Milan
- > Milan to ≤ UCSF
- > UCSF
milan and ucsf criteria
Milan criteria
- single tumor ≤ 5 cm, or
- 2 or 3 tumors, each ≤ 3 cm
UCSF criteria
- single tumor ≤ 6.5 cm, or
- 2 or 3 tumors, each ≤ 4.5 cm
- total tumor diameter ≤ 8 cm
statistical analysis
Chi-Square tests assessed associations of IML coordinates with post-liver transplant recurrent HCC. Confounders (age, sex, race, MELD, wait-time, pre-liver transplant HCC treatment, AFP, DRI) were assessed.
insufficient data
Of the 64 potential combinations of IML, only 30 make clinical sense as max can not be less than initial or last. Of those 30 clinically viable combinations, 10 did not have sufficient power and 3 combinations did not occur in the available data, leaving 17 IML combinations with sufficient power to predict post-liver transplant recurrent HCC.
app development team
Scott W. Biggins, MD, MAS:
Dr. Biggins is a transplant hepatologist and the Chief of Hepatology at the University of Washington in Seattle, WA. Dr. Biggins and his research team from the University of Washington, University of Colorado and the University of California San Francisco developed the RH-IML calculator.
Research Team:
Scott W. Biggins, Philip Vutien, Jennifer L. Dodge, Kiran M. Bambha, Eric M. Nordstrom, Jane Gralla, Kristen Campbell, Clair Levek, Trevor L. Nydam, Oren K. Fix, George Ioannou
Oren Fix, MD, MSc:
Dr. Fix is the Medical Director of Liver Transplantation and a Lead Informatics Physician at the University of North Carolina at Chapel Hill
