Textbook outcomes analysis of patients undergoing liver transplantation as treatment of hepatocellular carcinoma

Presenter: Alejandro Rodarte MD | Cleveland Clinic Foundation Background: Textbook outcome (TO) is a composite, all or nothing summary measure that includes multiple desirable post-operative measures. When achieved, TO represents the ideal (hence the name "textbook") hospitalization and may be superior to individual outcome measures for the analysis of perioperative care. Here, we aim to define and assess TO among patients undergoing liver transplantation (LT) as their treatment for hepatocellular carcinoma (HCC). Methods: This post-hoc study involved a cohort of patients with HCC who underwent LT at the Cleveland Clinic between 2002 and 2014. TO was defined by the absence of perioperative transfusions, prolonged length of stay, severe complications (Clavien-Dindo >=III), 30-day readmissions, and 30-day mortality. Results: A total of 389 patients were included, of whom 30.1% achieved TO. On multivariate regression analysis, being older than 60 years (odds ratio [OR], 0.43 [95% CI0.24-0.76]; P=0.004) and having microvascular invasion on explant pathology (OR, 0.40 [0.18-0.83]; P= 0.017) predicted worse TO rates. Male sex (OR, 2.14 [95% CI, 1.06-4.58]; P=0.004) and a low MELD score (≤12) (OR, 3.09 [95% CI, 1.63-6.02]; P= < 0.001) predicted better TO rates. The overall 5-year survival rate was 73.5%, the 10-year survival rate was 61.4%, and the tumor recurrence rate was 15.4%. The average time to recurrence was 32 (range, 2-172) months. Conclusion: In patients undergoing liver transplantation for HCC, the perioperative mortality is approximately 2%. TO, on the other hand, was achieved by only about 30% of our patients, providing a valuable measure of perioperative quality.