Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region
| Autor: | Alejandro Soza, Mario Vilatobá, Fernando Rubinstein, Rodrigo Zapata, Carla Bermudez, Ricardo Chong Menéndez, Rodrigo Figueroa, Federico G. Villamil, Josemaría Menéndez, Luisa Santos, Diego Arufe, Aline Lopes Chagas, Martín Padilla, Elaine Cristina de Ataide, Claudia Maccali, Flair José Carrilho, Agnaldo Soares Lima, J Mattera, Luis G. Podesta, Sergio Iván Hoyos Duque, Marcelo Silva, Martín Maraschio, Sebastián Marciano, Adriana Varón, Ilka de Fátima Santana Ferreira Boin, Federico Piñero, Margarita Anders, Adrián Gadano, Emilio Quiñonez, Jaime Poniachik, Linda Muñoz, Rodrigo Vergara Sandoval, Lucas McCormack |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Carcinoma Hepatocellular medicine.medical_treatment education 030230 surgery Liver transplantation Milan criteria Cohort Studies 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Prospective Studies Retrospective Studies Transplantation business.industry Patient Selection Liver Neoplasms medicine.disease digestive system diseases Liver Transplantation Hepatocellular carcinoma Ethical concerns 030211 gastroenterology & hepatology Waitlist mortality Neoplasm Recurrence Local business Cohort study |
| Zdroj: | Transplant international : official journal of the European Society for Organ TransplantationReferences. 34(1) |
| ISSN: | 1432-2277 |
| Popis: | This study aimed to compare liver transplantation (LT) outcomes and evaluate the potential rise in numbers of LT candidates with hepatocellular carcinoma (HCC) of different allocation policies in a high waitlist mortality region. Three policies were applied in two Latin American cohorts (1085 HCC transplanted patients and 917 listed patients for HCC): (i) Milan criteria with expansion according to UCSF downstaging (UCSF-DS), (ii) the AFP score, and (iii) restrictive policy or Double Eligibility Criteria (DEC; within Milan + AFP score ≤2). Increase in HCC patient numbers was evaluated in an Argentinian prospective validation set (INCUCAI; NCT03775863). Expansion criteria in policy A showed that UCSF-DS [28.4% (CI 12.8-56.2)] or "all-comers" [32.9% (CI 11.9-71.3)] had higher 5-year recurrence rates compared to Milan, with 10.9% increase in HCC patients for LT. The policy B showed lower recurrence rates for AFP scores ≤2 points, even expanding beyond Milan criteria, with a 3.3% increase. Patients within DEC had lower 5-year recurrence rates compared with those beyond DEC [13.3% (CI 10.1-17.3) vs 24.2% (CI 17.4-33.1; P = 0.0006], without significant HCC expansion. In conclusion, although the application of a stricter policy may optimize the selection process, this restrictive policy may lead to ethical concerns in organ allocation (NCT03775863). |
| Databáze: | OpenAIRE |
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