Dr. Karim Halazun Chosen for ASTS Vanguard Prize

November 2014

The Foundation of the American Society of Transplant Surgeons has awarded Karim Halazun, MD, the 2015 ASTS Vanguard Prize for his paper entitled, "Standing the Test of Time: Outcomes of a Decade of Prioritizing Patients with HCC, Results of the UNOS Natural Geographic Experiment," published in Hepatology.

The Vanguard Prize was established by the ASTS to recognize and honor outstanding contributions by its junior members for best papers published within the preceding eighteen months.

The paper compared survival for patients undergoing liver transplantation for hepatocellular carcinoma (HCC ) in long waiting times regions (LWTR) and short waiting times regions (SWTR) by analyzing national data from the United Network for Organ Sharing database. The authors concluded that patients with HCC who undergo liver transplant after a short time on the waiting list have a statistically lower chance of survival than those who wait longer.

The results suggest that early access to liver transplantation for patients with HCC is detrimental to overall survival despite decreasing the risk of wait list dropout. Improved survival in the LWTR existed both on an intent-to-treat analysis and in a post-transplant survival analysis, despite a higher proportion of T3 patients being transplanted in the LWTR. Listing and being transplanted in the LWTR was associated with better outcome in multivariable analysis, conferring a 20% greater chance of improved survival when compared to listing in a SWTR.

"One possible explanation is that HCC patients can be transplanted in short waiting times regions before physicians know how aggressive their particular tumors are, which can lead to poorer outcomes," says Dr. Halazun. "In long waiting times regions, patients with tumors that progress drop off the list if the tumor becomes too advanced. Another hypothesis is that HCC patients in long waiting times regions have the opportunity to receive neo-adjuvant treatment such as transarterial chemo-embolization, which can prevent progression during waiting time as well as decrease the risk of seeding during transplantation. Tumor biology is currently crudely assessed in HCC patients by way of radiologic imaging. Time however, may be the best available index of tumor biology, as aggressive cancers will manifest themselves if observed for a long enough period.”

The award will be formally presented to Dr. Halazun at the 15th ASTS State of the Art Winter Symposium: Transplant: The Ultimate Team Sport, which is scheduled for January 15-18, 2015, at the Loews Miami Beach Hotel.

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