Evaluation of the Intention-to-Treat Benefit of Living Donation in Patients With Hepatocellular Carcinoma Awaiting a Liver Transplant
| Autor: | Maria Hoppe-Lotichius, Massimo Rossi, Andre Gorgen, Jan Lerut, Toshimi Kaido, Karim J. Halazun, Tiffany C.L. Wong, Arvinder S. Soin, Zhe Yang, Gianluca Mennini, Alessandro Vitale, Shusen Zheng, Quirino Lai, Jean C. Emond, Benedikt Schaefer, Chao-Long Chen, Prashant Bhangui, Umberto Cillo, Chih Che Lin, Anna Chiara Frigo, Shinji Uemoto, Gonzalo Sapisochin, Armin Finkenstedt, Samuele Iesari, Toru Ikegami, Yuji Soejima, Jens Mittler, Chung Mau Lo |
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| Přispěvatelé: | UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC - Institut de recherche expérimentale et clinique |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty Intention-to-treat analysis Carcinoma Hepatocellular Referral business.industry medicine.medical_treatment Liver Neoplasms Transplant Waiting List Liver transplantation Liver Transplantation Transplantation Donation Cohort medicine Living Donors Humans Surgery Neoplasm Recurrence Local business Cohort study Original Investigation |
| Zdroj: | JAMA Surg JAMA Surgery, Vol. 156, no. 9, p. e213112 (2021) |
| Popis: | IMPORTANCE: Living-donor liver transplant (LDLT) offers advantages over deceased-donor liver transplant (DDLT) of improved intention-to-treat outcomes and management of the shortage of deceased-donor allografts. However, conflicting data still exist on the outcomes of LDLT in patients with hepatocellular carcinoma (HCC). OBJECTIVE: To investigate the potential survival benefit of an LDLT in patients with HCC from the time of waiting list inscription. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study with an intention-to-treat design analyzed the data of patients aged 18 years or older who had an HCC diagnosis and were on a waiting list for a first transplant. Patients from 12 collaborative centers in Europe, Asia, and the US who were on a transplant waiting list between January 1, 2000, and December 31, 2017, composed the international cohort. The Toronto cohort comprised patients from 1 transplant center in Toronto, Ontario, Canada who were on a waiting list between January 1, 2000, and December 31, 2015. The international cohort centers performed either an LDLT or a DDLT, whereas the Toronto cohort center was selected for its capability to perform both LDLT and DDLT. The benefit of LDLT was tested in the 2 cohorts before and after undergoing an inverse probability of treatment weighting (IPTW) analysis. Data were analyzed from February 1 to May 31, 2020. MAIN OUTCOMES AND MEASURES: Intention-to-treat death was defined as a patient death that occurred for any reason and was calculated from the time of waiting list inscription for liver transplant to the last follow-up date (December 31, 2019). Four multivariable Cox proportional hazards regression models for intention-to-treat death were created. RESULTS: A total of 3052 patients were analyzed in the international cohort, of whom 2447 were men (80.2%) and the median (IQR) age at first referral was 58 (53-63) years. The Toronto cohort comprised 906 patients, of whom 743 were men (82.0%) and the median (IQR) age at first referral was 59 (53-63) years. In all the settings, LDLT was an independent protective factor, reducing the risk of overall death by 49% in the pre-IPTW analysis for the international cohort (HR, 0.51; 95% CI, 0.36-0.71; P |
| Databáze: | OpenAIRE |
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