A Novel Model Measuring the Harm of Transplanting Hepatocellular Carcinoma Exceeding Milan Criteria
| Autor: | S. Vijan, Jorge A. Marrero, Michael L. Volk |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Pediatrics Carcinoma Hepatocellular Waiting Lists medicine.medical_treatment education Milan criteria Liver transplantation Living Donors medicine Humans Immunology and Allergy Pharmacology (medical) Survival analysis Retrospective Studies Transplantation business.industry Patient Selection Graft Survival Liver Neoplasms Retrospective cohort study medicine.disease Survival Analysis Markov Chains Tissue Donors Liver Transplantation Surgery Treatment Outcome Hepatocellular carcinoma Cohort Liver cancer business Neoplasm Transplantation |
| Zdroj: | American Journal of Transplantation. 8:839-846 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/j.1600-6143.2007.02138.x |
| Popis: | No empirical studies have defined the posttransplant survival that would justify expansion of the Milan criteria for liver transplantation of hepatocellular carcinoma. We created a Markov model comparing the survival benefit of transplantation for a patient with >Milan HCC, versus the harm caused to other patients on the waiting list. In the base-case analysis, the strategy of transplanting the patient with >Milan HCC resulted in a 44% increased risk of death and a utility loss of 3 quality-adjusted years of life across the pre- and posttransplant periods for a nationally representative cohort of patients on the waiting list. This harm outweighed the benefit of transplantation for a patient with >Milan HCC having a 5-year posttransplant survival of less than 61%. This survival threshold was most sensitive to geographic variations in organ shortage, with the threshold varying from 25% (Region 3) to >72% (Regions 1, 5, 7 and 9). In conclusion, expansion of the Milan criteria will require demonstrating high survival rates for the newly eligible patients-approximately 61% at 5 years after transplantation. In regions with less severe organ shortage, a more aggressive approach to transplanting these patients may be justified. |
| Databáze: | OpenAIRE |
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