Living Donor Liver Transplantation for Hepatocellular Carcinoma Within and Outside Traditional Selection Criteria: A Multicentric North American Experience.

Autor:	Ivanics T; Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Canada.; Department of Surgery, Henry Ford Hospital, Detroit, MI.; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden., Claasen MPAW; Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Canada.; Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands., Samstein B; Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medicine, New York, NY., Emond JC; Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York Presbyterian Hospital, NY., Fox AN; Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York Presbyterian Hospital, NY., Pomfret E; Department of Surgery, Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO., Pomposelli J; Department of Surgery, Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO., Tabrizian P; Recanati/Miller Transplantation Institute, Division of Abdominal Transplantation, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Florman SS; Recanati/Miller Transplantation Institute, Division of Abdominal Transplantation, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY., Mehta N; Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA., Roberts JP; Department of Surgery, University of California, San Francisco, San Francisco, CA., Emamaullee JA; Department of Surgery, University of Southern California, Los Angeles, CA., Genyk Y; Department of Surgery, University of Southern California, Los Angeles, CA., Hernandez-Alejandro R; Department of Surgery, Division of Transplantation/Hepatobiliary Surgery, University of Rochester, NY., Tomiyama K; Department of Surgery, Division of Transplantation/Hepatobiliary Surgery, University of Rochester, NY., Sasaki K; Department of Surgery-Abdominal Transplantation, Stanford Hospital and Clinics, Palo Alto, CA., Hashimoto K; Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH., Nagai S; Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Hospital, Detroit., Abouljoud M; Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Hospital, Detroit., Olthoff KM; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Hoteit MA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Heimbach J; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN., Taner T; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN., Liapakis AH; Department of Medicine, NYU Langone Health, New York, NY., Mulligan DC; Department of Surgery, Yale School of Medicine, New Haven, CT., Sapisochin G; Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Canada., Halazun KJ; NYU Langone Transplant Institute, NYU Langone Health, New York, NY.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jan 01; Vol. 279 (1), pp. 104-111. Date of Electronic Publication: 2023 Jul 31.
DOI:	10.1097/SLA.0000000000006049
Abstrakt:	Objective: To evaluate long-term oncologic outcomes of patients post-living donor liver transplantation (LDLT) within and outside standard transplantation selection criteria and the added value of the incorporation of the New York-California (NYCA) score. Background: LDLT offers an opportunity to decrease the liver transplantation waitlist, reduce waitlist mortality, and expand selection criteria for patients with hepatocellular carcinoma (HCC). Methods: Primary adult LDLT recipients between October 1999 and August 2019 were identified from a multicenter cohort of 12 North American centers. Posttransplantation and recurrence-free survival were evaluated using the Kaplan-Meier method. Results: Three hundred sixty LDLTs were identified. Patients within Milan criteria (MC) at transplantation had a 1, 5, and 10-year posttransplantation survival of 90.9%, 78.5%, and 64.1% versus outside MC 90.4%, 68.6%, and 57.7% ( P = 0.20), respectively. For patients within the University of California San Francisco (UCSF) criteria, respective posttransplantation survival was 90.6%, 77.8%, and 65.0%, versus outside UCSF 92.1%, 63.8%, and 45.8% ( P = 0.08). Fifty-three (83%) patients classified as outside MC at transplantation would have been classified as either low or acceptable risk with the NYCA score. These patients had a 5-year overall survival of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplantation would have been classified as a low or acceptable risk with a 5-year overall survival of 65.3%. Conclusions: Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-year rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria. Competing Interests: G.S. discloses consultancy for Astra-Zeneca, Roche, Evidera, Novartis, and Integra. He has received financial compensation for talks for Roche, Astra-Zeneca, Chiesi, and Integra. Also, he has received a grant from Roche. The remaining authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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