T. Tara Ghaziani

All Publications

• Decreased urgency among liver transplant candidates with hepatocellular carcinoma in the United States. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Kwong, A. J., Ghaziani, T. T., Mehta, N. 2021

  Abstract

  Early-stage hepatocellular carcinoma (HCC) has been an accepted indication for liver transplantation now for over 20 years. Allocation policy in the United States (US) has been continually refined to maintain equity and optimize the utility of transplant for HCC, yet all patients qualifying for HCC exception still receive the same number of points. This group is quite heterogeneous, with varying risk of waitlist dropout dependent on tumor characteristics including number and size of lesions and alpha-fetoprotein (AFP) level, as well as baseline liver function. In addition, changing demographics of liver disease, including the rising incidence of NASH, effective antiviral therapy for hepatitis C virus, and earlier detection of HCC due to improved screening programs and awareness, may influence the overall survival benefit to liver transplantation.

  View details for DOI 10.1002/lt.26373

  View details for PubMedID 34806834

• THE INCIDENCE OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS B VIRUS INFECTION SUBJECTS WITH CIRRHOSIS NOT MEETING CURRENT TREATMENT GUIDANCE Alshuwaykh, O., Goel, A., Ghaziani, T., Daugherty, T., Dhanasekaran, R., Ahmed, A., Dronamraju, D., Kwong, A. J., Nguyen, M. H., Cheung, A., Kwo, P. WILEY. 2021: 500A-501A

  View details for Web of Science ID 000707188002225

• National Trends and Waitlist Outcomes of Locoregional Therapy among Liver Transplant Candidates with Hepatocellular Carcinoma in the United States. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association Kwong, A. J., Ghaziani, T. T., Yao, F., Sze, D., Mannalithara, A., Mehta, N. 2021

  Abstract

  BACKGROUND & AIMS: Policy changes in the United States (US) have overall lengthened waiting times for patients with hepatocellular carcinoma (HCC). We investigate temporal trends in utilization of locoregional therapy (LRT) and associated waitlist outcomes among liver transplant (LT) candidates in the US.METHODS: Data for primary adult LT candidates listed from 2003-2018 who received HCC exception were extracted from the OPTN database. Explant histology was examined, and multivariable competing risk analysis was used to evaluate the association between LRT type and waitlist dropout.RESULTS: There were 31,609 eligible patients with at least one approved HCC exception, and 34,610 treatments among 24,145 LT candidates. The proportion with at least one LRT recorded increased from 42.3% in 2003 to 92.4% in 2018. Chemoembolization remains the most frequent type, followed by thermal ablation, with a notable increase in radioembolization from 3% in 2013 to 19% in 2018. Increased incidence of LRT was observed among patients with tumor burden beyond Milan, higher AFP, and more compensated liver disease. Receipt of any type of LRT was associated with a lower risk of waitlist dropout; there were no significant differences by number of LRT. In IPTW-adjusted analysis, radioembolization or ablation as the first LRT was associated with reduced risk of waitlist dropout compared to chemoembolization.CONCLUSIONS: In a large nationwide cohort of LT candidates with HCC, LRT and in particular radioembolization was increasingly used to bridge to LT. Patients with greater tumor burden and those with more compensated liver disease received more treatments while awaiting LT. Bridging LRT was associated with a lower risk of waitlist dropout.

  View details for DOI 10.1016/j.cgh.2021.07.048

  View details for PubMedID 34358718

• How Clinicians May Use Tests of Hepatic Function Now and In the Future. Translational research : the journal of laboratory and clinical medicine Ghaziani, T. T., Kwo, P. Y. 2021

  View details for DOI 10.1016/j.trsl.2021.03.014

  View details for PubMedID 33826945

• Down-staging Outcomes for Hepatocellular Carcinoma: Results from the Multicenter Evaluation of Reduction in Tumor Size before Liver Transplantation (MERITS-LT) Consortium. Gastroenterology Mehta, N., Frenette, C., Tabrizian, P., Hoteit, M., Guy, J., Parikh, N., Ghaziani, T. T., Dhanasekaran, R., Dodge, J. L., Natarajan, B., Holzner, M. L., Frankul, L., Chan, W., Fobar, A., Florman, S., Yao, F. Y. 2021

  Abstract

  United Network of Organ Sharing (UNOS) has adopted uniform criteria for down-staging (UNOS-DS) of hepatocellular carcinoma (HCC) prior to liver transplantation (LT), but down-staging success rate and intention-to-treat outcomes across broad geographic regions are unknown.In this first multi-regional study (7 centers, 4 UNOS regions), consecutive patients with HCC undergoing down-staging based on UNOS-DS criteria were prospectively evaluated from 2016-2019 (n=209).Probability of successful down-staging to Milan criteria and dropout at 2 years from initial down-staging procedure was 87.7% and 37.3%, respectively. Pre-treatment AFP-L3 >10% (HR 3.7, p=0.02) was associated with increased dropout risk. When comparing chemoembolization (n=132) and Y-90 radioembolization (n=62) as initial down-staging treatment, there were no differences in mRECIST response, probability of or time to successful down-staging, waitlist dropout or LT. Probability of LT at 3 years was 46.6% after a median of 17.2 months. In the explant, 17.5% had vascular invasion and 42.8% exceeded Milan criteria (under-staging). The only factor associated with under-staging was the sum of the number of lesions plus largest tumor diameter on last pre-LT imaging, and odds of under-staging increased by 35% per 1 unit increase in this sum. Post-LT survival at 2 years was 95% and HCC recurrence occurred in 7.9%.In this first prospective multi-regional study based on UNOS-DS criteria, we observed successful down-staging rate of >80%, and similar efficacy of chemoembolization and Y-90 radioembolization as initial down-staging treatment. A high rate of tumor under-staging was observed despite excellent 2-year post-LT survival of 95%. Additional LRT to reduce viable tumor burden may reduce tumor under-staging.

  View details for DOI 10.1053/j.gastro.2021.07.033

  View details for PubMedID 34331914

• Recent Progress in Systemic Therapy for Hepatocellular Cancer (HCC). Current Treatment Options in Gastroenterology Ghaziani, T., Dhanasekaran, R. 2021; 19 (1): 351–368

  View details for DOI 10.1007/s11938-021-00346-x

• THE INCIDENCE OF HEPATOCELLULAR CARCINOMA IN CHRONIC HEPATITIS B VIRUS INFECTION SUBJECTS NOT MEETING CRITERIA FOR ANTIVIRAL THERAPY Alshuwaykh, O., Goel, A., Daugherty, T., Cheung, A., Kim, W., Kwong, A. J., Ahmed, A., Ghaziani, T., Torok, N. J., Nguyen, M. H., Dronamraju, D., Dhanasekaran, R., Kumari, R., Kwo, P. Y. WILEY. 2020: 472A–473A

  View details for Web of Science ID 000574027001230

• Characterizing Ascites in Subjects With Nonhepatic Solid Tumors Alshuwaykh, O., Cheung, A., Goel, A., Dhanasekaran, R., Ahmed, A., Dronamraju, D., Daugherty, T., Kim, R. W., Kumari, R., Torok, N., Ghaziani, T., Kwo, P. Y. LIPPINCOTT WILLIAMS & WILKINS. 2020: S507

  View details for Web of Science ID 000607196702295

• Post-Transplant Outcomes in Older Patients with Hepatocellular Carcinoma (HCC) are Driven by non-HCC Factors. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Adeniji, N. n., Arjunan, V. n., Prabhakar, V. n., Mannalithara, A. n., Ghaziani, T. n., Ahmed, A. n., Kwo, P. n., Nguyen, M. n., Melcher, M. L., Busuttil, R. W., Florman, S. S., Haydel, B. n., Ruiz, R. M., Klintmalm, G. B., Lee, D. D., Taner, C. B., Hoteit, M. A., Verna, E. C., Halazun, K. J., Tevar, A. D., Humar, A. n., Chapman, W. C., Vachharajani, N. n., Aucejo, F. n., Nydam, T. L., Markmann, J. F., Mobley, C. n., Ghobrial, M. n., Langnas, A. N., Carney, C. A., Berumen, J. n., Schnickel, G. T., Sudan, D. L., Hong, J. C., Rana, A. n., Jones, C. M., Fishbein, T. M., Agopian, V. n., Dhanasekaran, R. n. 2020

  Abstract

  The incidence of hepatocellular carcinoma (HCC) is growing in the US, especially among the elderly. Older patients are increasingly getting transplanted for HCC, but the impact of advancing age on long-term post-transplant outcomes is not clear. To study this, we used data from the US Multicenter HCC Transplant Consortium (UMHTC) of 4980 patients. We divided the patients into 4 groups by age at transplantation- 18-64 (n = 4001), 65-69 (n = 683), 70-74 (n = 252) and ≥ 75 years (n = 44). There were no differences in HCC tumor stage, type of bridging locoregional therapy or explant residual tumor between the groups. Older age was confirmed to be an independent and significant predictor of overall survival even after adjusting for demographic, etiologic and cancer-related factors on multivariable analysis. A dose-response effect of age on survival was observed, with every 5-year increase in age over 50 years resulting in an absolute increase of 8.3% in the mortality rate. Competing risk analysis revealed that older patients experienced higher rates of non-HCC-related mortality (p = 0.004), and not HCC-related death (p = 0.24). To delineate the precise cause of death, we further analyzed a single-center cohort of patients transplanted for HCC (n = 302). Patients older than 65 years had a higher incidence of de-novo cancer (18.1% vs 7.6%, p = 0.006) after transplantation and higher overall cancer-related mortality (14.3% vs 6.6%, p = 0.03). CONCLUSION: Even carefully selected elderly patients with HCC have significantly worse post-transplant survival, which are mostly driven by non-HCC related causes. Minimizing immunosuppression and closer surveillance for de novo cancers can potentially improve outcomes in elderly patients transplanted for HCC.

  View details for DOI 10.1002/lt.25974

  View details for PubMedID 33306254