Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region / Sergio Iván Hoyos Duque  

Público ISBD Título : Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region Tipo de documento : documento electrónico Autores : Sergio Iván Hoyos Duque, Fecha de publicación : 2021 Títulos uniformes : Transplant International Idioma : Inglés (eng) Palabras clave : allocation  hepatocellular carcinoma  liver transplantation  selection Resumen : 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). Mención de responsabilidad : Federico Pinero, Margarita Anders, Ilka F. Boin, Aline Chagas, Emilio Quinonez, Sebastian Marciano, Mario Vilatoba, Luisa Santos, Sergio Hoyos Duque, Agnaldo Soares Lima, Josemaria Menendez, Martin Padilla, Jaime Poniachik, Rodrigo Zapata, Alejandro Soza, Martin Maraschio, Ricardo Chong Menendez, Linda Munoz, Diego Arufe, Rodrigo Figueroa, Elaine Cristina de Ataide, Claudia Maccali, Rodrigo Vergara Sandoval, Carla Bermudez, Luis G. Podesta, Lucas McCormack, Adriana Varon, Adrian Gadano, Juan Mattera, Federico Villamil, Fernando Rubinstein, Flair Carrilho & Marcelo Silva Referencia : Transpl Int. 2021 Jan;34(1):97-109. DOI (Digital Object Identifier) : 10.1111/tri.13767 PMID : 33040420 En línea : https://onlinelibrary.wiley.com/doi/10.1111/tri.13767 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5880 Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region [documento electrónico] / Sergio Iván Hoyos Duque,  . - 2021. Obra : Transplant International Idioma : Inglés (eng) Palabras clave : allocation  hepatocellular carcinoma  liver transplantation  selection Resumen : 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). Mención de responsabilidad : Federico Pinero, Margarita Anders, Ilka F. Boin, Aline Chagas, Emilio Quinonez, Sebastian Marciano, Mario Vilatoba, Luisa Santos, Sergio Hoyos Duque, Agnaldo Soares Lima, Josemaria Menendez, Martin Padilla, Jaime Poniachik, Rodrigo Zapata, Alejandro Soza, Martin Maraschio, Ricardo Chong Menendez, Linda Munoz, Diego Arufe, Rodrigo Figueroa, Elaine Cristina de Ataide, Claudia Maccali, Rodrigo Vergara Sandoval, Carla Bermudez, Luis G. Podesta, Lucas McCormack, Adriana Varon, Adrian Gadano, Juan Mattera, Federico Villamil, Fernando Rubinstein, Flair Carrilho & Marcelo Silva Referencia : Transpl Int. 2021 Jan;34(1):97-109. DOI (Digital Object Identifier) : 10.1111/tri.13767 PMID : 33040420 En línea : https://onlinelibrary.wiley.com/doi/10.1111/tri.13767 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5880

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