Liver transplantation for hepatocellular carcinoma in clinical practice: the lesson from a 20-year multicentre experience in Italy
| Autor: | Farinati Fabio, Giacomin Anna, Vanin Veronica, Sergio Adriana, Burra Patrizia, Cillo Umberto, Di Nolfo Annamaria, Del Poggio Paolo, Benvegnu Luisa, Zoli Marco, Borzio Franco, Giannini Edoardo, Caturelli Eugenio, Cazzagon Nora, Rapaccini Gian Ludovico, Trevisani Franco, for the Italian Liver Cancer (ITA. LI. CA) group, Andreone P, Bernardi M, Biselli M, Caraceni P, di Micoli A, Domenicali M, Magalotti D, Cappa FM, Santi V, Zambruni A, Balsamo C, Di Marco M, Vavassori E, Gilardoni L, Mattiello M, Alberti A, Gatta A, Gios M, Molaro M, Sala M, Savarino V, Risso D, Ghittoni G, Roselli P, Grazi GL, Nardo B, Ravaioli M, Pinna AD, Giampalma E, Golfieri R |
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| Přispěvatelé: | Farinati Fabio, Giacomin Anna, Vanin Veronica, Sergio Adriana, Burra Patrizia, Cillo Umberto, Di Nolfo Annamaria, Del Poggio Paolo, Benvegnu Luisa, Zoli Marco, Borzio Franco, Giannini Edoardo, Caturelli Eugenio, Cazzagon Nora, Rapaccini Gian Ludovico, Trevisani Franco, for the Italian Liver Cancer (ITA.LI.CA) group [.., Andreone P, Bernardi M, Biselli M, Caraceni P, di Micoli A, Domenicali M, Magalotti D, Cappa FM, Santi V, Zambruni A, Balsamo C, Di Marco M, Vavassori E, Gilardoni L, Mattiello M, Alberti A, Gatta A, Gios M, Molaro M, Sala M, Savarino V, Risso D, Ghittoni G, Roselli P, Grazi GL, Nardo B, Ravaioli M, Pinna AD, Giampalma E, Golfieri R, ] |
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Carcinoma Hepatocellular medicine.medical_treatment Liver transplantation Guideline Gastroenterology Internal medicine Carcinoma Medicine Humans guidelines neoplasms Selection (genetic algorithm) Aged Hepatology business.industry General surgery HEPATOCELLULAR CARCINOMA LIVER TRANSPLANTATION Guidelines Evidence-based approach Patient Selection Liver Neoplasms hepatocellular carcinoma evidence-based approach liver transplantation Middle Aged medicine.disease Prognosis digestive system diseases Liver Transplantation Neoplasm Proteins Clinical Practice Transplantation Treatment Outcome Italy Hepatocellular carcinoma Practice Guidelines as Topic Female Guideline Adherence alpha-Fetoproteins business Epidemiologic Methods |
| Zdroj: | European journal of gastroenterologyhepatology. 24(2) |
| ISSN: | 1473-5687 |
| Popis: | INTRODUCTION: Hepatocellular carcinoma (HCC) is an established indication for liver transplantation (LT), but the selection criteria and priority are still debated. AIMS: To ascertain the number and features of patients with HCC who undergo transplantation in a Western country, the number of patients eligible for LT according to the American Association for the Study of Liver Diseases (AASLD) guidelines, the number of patients who actually undergo transplantation and whether adherence affects survival. METHODS: This is a retrospective analysis from a multicentre Italian database of 2042 cases of HCC, recruited prospectively and consecutively. Kaplan-Meier (log rank) and Cox multivariate analysis estimated survival. RESULTS: Patients who had undergone transplantation (50, 2.5%, with no change over time) had a median survival of 133 months, significantly influenced by the number of lesions and alpha-fetoprotein levels, which were found to be independent predictors of survival on multivariate analysis. Milan criteria were fulfilled in 68%, impacting on survival, whereas 48% fulfilled AASLD guidelines, without such an impact. Two hundred and twenty-eight (11%) patients were eligible for LT according to AASLD; in this group, alpha-fetoprotein levels and Child-Pugh class were independent predictors of survival. CONCLUSION: Among patients with HCC, those undergoing LT represent a small minority; even fewer (1%) are those who undergo transplantation according to AASLD guidelines, adherence to which only marginally affects survival. Overall, LT impact on HCC patients' treatment is very limited |
| Databáze: | OpenAIRE |
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