Table 2.
Staging and Priority Classification of HCC in the LT Setting: Patient Stratification According to Allocation Principles
| TT Categories | Priority According to HCC Dropout Models | Priority According to Transplantation Benefit | Priority Perception of Patient and Societal Expectations |
|---|---|---|---|
| TT0C | Very Low | Low | Low |
| No residual tumor after curative treatment of HCC | Very low risk of dropout in cured HCC | Transplantation benefit depends on MELD score only | The patient should not undergo transplantation |
| TT0L | Low‐Intermediate | Low | Intermediate |
| No residual tumor after locoregional embolo‐therapies for transplantable HCC | Low risk of dropout in cured HCC | Transplantation benefit depends on HCC‐MELD | The patient was eligible for transplantation but can be placed on hold because the tumor seems to be cured |
| TT1 | Low | Low | Low |
| Single HCC ≤2 cm | Low risk of dropout in very early HCC | Low benefit in presence of alternative nontransplantation treatments | The patient should not undergo transplantation if there are other treatment options |
| TT0NT | Not Applicable | Low | Low |
| No residual tumor after treatment of a nontransplantable HCC (successful downstaging) | NT HCC should not be listed up front, similarly to non‐HCC in patients with low MELD scores | Transplantation benefit depends on MELD score only | The patient was not eligible for transplantation and has been cured by other means |
| TTFR | Intermediate | Intermediate | High |
| Transplantable HCC > T1 at first presentation or recurrent HCC >2 years after curative treatment | Demonstrated increase of dropout risk over time for both size and number parameters | Benefit depends on true applicability of alternative treatments | This patient has the best posttransplantation survival (utility) |
| TTUT | Intermediate | High | High |
| Transplantable HCC judged untreatable for reasons not captured by MELD (i.e., ascites) | Increased dropout risk; short time to liver decompensation | There is no therapeutic alternative for HCC | The patient is expected to have good utility posttransplantation |
| TTPR | Intermediate/High | High | High |
| Partial response after complete bridge therapy in a transplantable tumor | Risk of selection of biologically aggressive clones with increased proliferative activity | Failure of a bridge therapy with no residual therapeutic alternative | The patient is expected to have good utility posttransplantation |
| TTDR | Intermediate/High | High | High |
| Transplant eligibility after downstaging (sustained partial response) or recurrent HCC <2 years after curative treatment of any HCC | High dropout risk over time for both size and number parameters | Benefit depends on absence of true alternative treatments | Transplantation should be offered in relatively stable patients before it is too late |