Evidence map›Paper›PMID 28353492›Full record

ArticleTransplantation2017

Wait Time of Less Than 6 and Greater Than 18 Months Predicts Hepatocellular Carcinoma Recurrence After Liver Transplantation: Proposing a Wait Time "Sweet Spot".

Neil Mehta, Julie Heimbach, David Lee, Jennifer L Dodge, Denise Harnois, Justin Burns, William Sanchez, John P Roberts, Francis Y Yao

Open access · greenAbstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Transplantation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 3 pooled it
5.8field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 3 syntheses or guidelines pooled it, 87 citations in OpenAlex.

  1. Guideline
  2. Guideline
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  5. Improving surgical treatments for hepatocellular carcinoma.Nature reviews. Gastroenterology & hepatology · 2026
    Review
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  7. Article
  8. Article
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  14. Reduction in Racial and Ethnic Disparity in Survival Following Liver Transplant for Hepatocellular Carcinoma in the Direct-acting Antiviral Era.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2023
    Article
  15. Review
  16. Article
  17. Article
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  19. Holistic management of hepatocellular carcinoma: The hepatologist's comprehensive playbook.Liver international : official journal of the International Association for the Study of the Liver · 2022
    Review
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

Neil Mehta1 Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA. 2 Division of Transplantation, Department of Surgery, Mayo Clinic, Rochester, MN. 3 Department of Transplantation, Mayo Clinic, Jacksonville, FL. 4 Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, CA. 5 Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN.
Julie Heimbach
David Lee
Jennifer L Dodge
Denise Harnois
Justin Burns
William Sanchez
John P Roberts
Francis Y Yao
University of California, San Francisco · USMayo Clinic in Florida · USMayo Clinic in Arizona · US

Funding

UCSF Liver Core CenterP30DK026743 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Holger Willenbring · 1986 to 2026
$30.7M
NIDDK NIH HHS P30 DK026743
6 · The paper itself

Abstract

backgroundIt has been postulated that short wait time before liver transplant (LT) for hepatocellular carcinoma (HCC) results in the inclusion of tumors with aggressive biology, but prolonged wait time could result in a shift to more aggressive tumor behavior. We therefore test the hypothesis that a wait time "sweet spot" exists with a lower risk for HCC recurrence compared with the other 2 extremes.

methodsThis multicenter study included 911 patients from 3 LT centers with short, medium, and long wait times (median of 4, 7, and 13 months, respectively) who received Model for End Stage Liver Disease exception listing for HCC from 2002 to 2012.

resultsWait time, defined as time from initial HCC diagnosis to LT, was less than 6 months in 32.4%, 6 to 18 months in 53.7%, and greater than 18 months in 13.9%. Waitlist dropout was observed in 18.4% at a median of 11.3 months. Probability of HCC recurrence at 1 and 5 years were 6.4% and 15.5% with wait time of less than 6 or greater than 18 months (n = 343) versus 4.5% and 9.8% with wait time of 6 to 18 months (n = 397), respectively (P = 0.049). When only pre-LT factors were considered, wait time of less than 6 or greater than 18 months (HR, 1.6; P = 0.043) and AFP greater than 400 at HCC diagnosis (HR, 3.0; P < 0.001) predicted HCC recurrence in multivariable analysis.

conclusionsThis large multicenter study provides evidence of an association between very short (<6 months) or very long (>18 months) wait times and an increased risk for HCC recurrence post-LT. The so-called sweet spot of 6 to 18 months should be the target to minimize HCC recurrence.

Indexed as

Neoplasm Recurrence, LocalTime-to-TreatmentWaiting ListsAgedCarcinoma, HepatocellularDisease ProgressionFemaleHumansKaplan-Meier EstimateLiver Function TestsLiver NeoplasmsLiver TransplantationMaleMiddle AgedMultivariate AnalysisPatient Dropouts

Identifiers

PMID28353492
PMCPMC5568965
OpenAlexW2603017800

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.