Including mRECIST in the Metroticket 2.0 criteria improves prediction of hepatocellular carcinoma-related death after liver transplant.

ABSTRACT BACKGROUND S AIMS: The weight of response to neo-adjuvant therapies, to select candidates with hepatocellular carcinoma (HCC) for liver transplantation (LT) at acceptable risk of recurrence, remains partially unsolved for most of post-LT prediction models. Aim of this study was to embed radiological response in the Metroticket 2.0 model for post-LT prediction of “HCC-related death” to provide more usefulness in the modern clinical scenario. METHODS Data from 859 transplanted patients (2000-2015) who received neo-adjuvant therapies were included. The last radiological assessment before LT was reviewed according to the mRECIST criteria. Competing-risk analysis was applied. The added value of including radiological response into the Metroticket 2.0 was explored through the category-based Net Reclassification Improvement (NRI). RESULTS At last radiological assessment prior to LT, complete response (CR) was diagnosed in 41.3%, partial response/stable disease (PR/SD) in 24.9% and progressive disease (PD) in 33.8%. Patients with CR had 5-year rates of “HCC-related death” of 3.1%, those with PR/SD had 9.6% and those with PD had 13.4% (P CONCLUSION Inclusion of mRECIST criteria within the Metroticket 2.0 framework can provide further clinical information when judging eligibility for candidates to LT who received neo-adjuvant therapies.