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Di Sandro S, Centonze L, Catellani B, Odorizzi R, Caracciolo D, Guidetti C, Magistri P, Esposito G, Guerrini GP, Di Benedetto F. Current role and perspectives of living donor liver transplantation for hepatocellular carcinoma: systematic review of the past 20 years. Updates Surg 2024:10.1007/s13304-024-01862-y. [PMID: 38704462 DOI: 10.1007/s13304-024-01862-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
Hepatocellular carcinoma (HCC) poses a significant global health challenge, and liver transplantation (LT) remains the best curative option. Living donor liver transplantation (LDLT) emerged as a potential solution to organ scarcity, reducing waitlist times. This comprehensive review explores LDLT practices, focusing on patient selection criteria and oncologic outcomes. A systematic review following PRISMA guidelines included 50 studies (2004-2023) with 8062 patients. Data encompassed baseline characteristics, HCC features, and oncologic outcomes. Further analysis categorized results by geography and publication year. Heterogeneity in patient demographics, tumor burden, and transplant characteristics was observed. Recent LDLT series demonstrated a shift towards refined selection criteria, increased neoadjuvant treatment, and improved oncologic outcomes. Geographic disparities revealed unique challenges in Eastern and Western practices. LDLT proves effective for HCC, addressing donor shortages. Evolving practices highlight the importance of refining inclusion criteria and optimizing tumor management. While geographic differences exist, LDLT, when judiciously applied, offers promising outcomes.
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Affiliation(s)
- Stefano Di Sandro
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Leonardo Centonze
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Catellani
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Odorizzi
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Daniela Caracciolo
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Cristiano Guidetti
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Paolo Magistri
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Giuseppe Esposito
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Piero Guerrini
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabrizio Di Benedetto
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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Wicks JS, Dale BS, Ruffolo L, Pack LJ, Dunne R, Laryea MA, Hernandez-Alejandro R, Sharma AK. Comparable and Complimentary Modalities for Treatment of Small-Sized HCC: Surgical Resection, Radiofrequency Ablation, and Microwave Ablation. J Clin Med 2023; 12:5006. [PMID: 37568408 PMCID: PMC10419984 DOI: 10.3390/jcm12155006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Over the past decade, there has been continual improvement in both ablative and surgical technologies for the treatment of hepatocellular carcinoma (HCC). The efficacy of ablative therapy compared to surgical resection for HCC has not been thoroughly evaluated using multiple large-scale randomized controlled trials. By international consensus, if a patient is eligible, surgery is the primary curative treatment option, as it is believed to confer superior oncologic control. OBJECTIVE to determine the efficacies of percutaneous ablative therapies and surgical resection (SR) in the treatment of HCC. Data sources, study appraisal, and synthesis methods: A meta-analysis using 5 online databases dating back to 1989 with more than 31,000 patients analyzing patient and tumor characteristics, median follow-up, overall survival, and complication rate was performed. RESULTS Ablative therapies are suitable alternatives to surgical resection in terms of survival and complication rates for comparable patient populations. For the entire length of the study from 1989-2019, radiofrequency ablation (RFA) produced the highest 5-year survival rates (59.6%), followed by microwave ablation (MWA) (50.7%) and surgical resection (SR) (49.9%). In the most recent era from 2006 to 2019, surgical resection has produced the highest 5-year survival rate of 72.8%, followed by RFA at 61.7% and MWA at 50.6%. Conclusions and key findings: Depending on the disease state and comorbidities of the patient, one modality may offer superior overall survival rates over the other available techniques. Interventional ablative methods and surgical resection should be used in conjunction for the successful treatment of small-sized HCC.
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Affiliation(s)
- Jeffrey S. Wicks
- Department of Biology, University of Rochester, Rochester, NY 14642, USA;
| | - Benjamin S. Dale
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA; (B.S.D.); (L.R.)
| | - Luis Ruffolo
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA; (B.S.D.); (L.R.)
| | - Ludia J. Pack
- Department of Genetics, University of Rochester, Rochester, NY 14642, USA;
| | - Richard Dunne
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, NY 14642, USA;
| | - Marie A. Laryea
- Division of Gastroenterology/Hepatology, Department of Medicine, University of Rochester, Rochester, NY 14642, USA;
| | | | - Ashwani Kumar Sharma
- Division of Interventional Radiology, Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA
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From a Philosophical Framework to a Valid Prognostic Staging System of the New "Comprehensive Assessment" for Transplantable Hepatocellular Carcinoma. Cancers (Basel) 2019; 11:cancers11060741. [PMID: 31142035 PMCID: PMC6627952 DOI: 10.3390/cancers11060741] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022] Open
Abstract
The comprehensive assessment of the transplantable tumor (TT) proposed and included in the last Italian consensus meeting still deserve validation. All consecutive patients with hepatocellular carcinoma (HCC) listed for liver transplant (LT) between January 2005 and December 2015 were post-hoc classified by the tumor/patient stage as assessed at the last re-staging-time (ReS-time) before LT as follow: high-risk-class (HRC) = stages TTDR, TTPR; intermediate-risk-class (IRC) = TT0NT, TTFR, TTUT; low-risk-class (LRC) = TT1, TT0L, TT0C. Of 376 candidates, 330 received LT and 46 dropped-out. Transplanted patients were: HRC for 159 (48.2%); IRC for 63 (19.0%); LRC for 108 (32.7%). Cumulative incidence function (CIF) of tumor recurrence after LT was 21%, 12%, and 8% at 5-years and 27%, 15%, and 12% at 10-years respectively for HRC, IRC, and LRC (P = 0.011). IRC patients had significantly lower CIF of recurrence after LT if transplanted >2-months from ReS-time (28% vs. 3% for <2 and >2 months, P = 0.031). HRC patients had significantly lower CIF of recurrence after-LT if transplanted <2 months from the ReS-time (10% vs. 33% for <2 and >2 months, P = 0.006). The proposed TT staging system can adequately describe the post-LT recurrence, especially in the LRC and HRC patients. The intermediate-risk-class needs to be better defined and further studies on its ability in defining intention-to-treat survival (ITT) and drop-out are required.
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Sotiropoulos GC, Spartalis E, Machairas N, Paul A, Malagó M, Neuhäuser M. Liver transplantation for hepatocellular carcinoma with live donors or extended criteria donors: a propensity score-matched comparison. Ann Gastroenterol 2018; 31:722-727. [PMID: 30386123 PMCID: PMC6191876 DOI: 10.20524/aog.2018.0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/29/2018] [Indexed: 12/27/2022] Open
Abstract
Background To compare patient survival after liver transplantation (LT) for hepatocellular carcinoma (HCC) from live donors (LD) or extended criteria donors (ECD). Methods Data from consecutive LT procedures for HCC involving either LD or ECD were reviewed. Patient survival was our primary outcome. Re-transplantation (Re-LT), ischemic type bile lesions (ITBL), and tumor recurrence represented secondary outcomes. The primary outcome was statistically analyzed using Kaplan-Meier estimates and Cox proportional hazards regression; logistic regression analyses were used for statistical analysis of the secondary outcomes. Propensity score was calculated based on patient age, sex, hepatitis C viral infection (HCV), laboratory model for end-stage liver disease (labMELD) score, bridging treatment, Milan criteria, α-fetoprotein levels, and tumor grade. Results The study evaluated 109 recipients undergoing LT from either LD (n=57) or ECD (n=52). LT procedure (hazard ratio [HR] 2.349, 95% confidence interval [CI] 1.151-4.794, P=0.0190), age (HR 1.075, 95%CI 1.020-1.133, P=0.0074) and labMELD score (HR 1.082, 95%CI 1.021-1.147, P=0.0075) reached significance by Cox proportional hazards regression. After adjustment with the propensity score (stratification with 5 strata), the LT procedure was still significant (HR 2.401, 95%CI 1.114-5.175, P=0.0253). Tumor grade (odds ratio [OR] 9.628, 95%CI 1.120-82.752, P=0.0391), labMELD score (OR 1.224, 95%CI 1.019-1.471, P=0.0306), and Milan criteria (OR 6.375, 95%CI 1.239-32.796, P=0.0267) gained statistical significance by logistic regression analysis for Re-LT, ITBL, and tumor recurrence, respectively. Conclusions LT for HCC showed superior patient survival with ECD rather than LD grafts. Re-LT, ITBL, and tumor recurrence showed no significant differences between the two groups. However, the diverging criteria for the definition of ECD grafts represent a considerable limitation for the wide application of this policy.
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Affiliation(s)
- Georgios C Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany (Georgios C. Sotiropoulos, Andreas Paul, Massimo Malagó).,Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece (Georgios C. Sotiropoulos, Eleftherios Spartalis, Nikolaos Machairas)
| | - Eleftherios Spartalis
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece (Georgios C. Sotiropoulos, Eleftherios Spartalis, Nikolaos Machairas)
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece (Georgios C. Sotiropoulos, Eleftherios Spartalis, Nikolaos Machairas)
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany (Georgios C. Sotiropoulos, Andreas Paul, Massimo Malagó)
| | - Massimo Malagó
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany (Georgios C. Sotiropoulos, Andreas Paul, Massimo Malagó).,Department of HPB and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK (Massimo Malago)
| | - Markus Neuhäuser
- Department of Mathematics and Technology, Koblenz University of Applied Science, Remagen, Germany (Markus Neuhäuser)
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Hu Z, Qian Z, Wu J, Zhou J, Zhang M, Zhou L, Zheng S. Clinical outcomes and risk factors of hepatocellular carcinoma treated by liver transplantation: A multi-centre comparison of living donor and deceased donor transplantation. Clin Res Hepatol Gastroenterol 2016; 40:315-326. [PMID: 26382281 DOI: 10.1016/j.clinre.2015.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The different outcomes of deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) are currently being debated. We aimed to retrospectively compare the outcomes following LDLT and DDLT and to analyse the factors influencing this. METHODS We compared the overall survival (OS) and disease-free survival (DFS) rates of HCC patients after LDLT (n=389) and DDLT (n=6471) from 81 centres over a 10-year period. OS and DFS rates were calculated with the Kaplan-Meier method. And univariate and multivariate Cox proportional hazards regressions were performed on the entire cohort to identify predictors. RESULTS Of 6860 patients, the 1-, 3-, and 5-year OS rates were 86.79%, 70.16%, and 66.31% after LDLT, respectively, and 74.2%, 54.21%, and 46.97% after DDLT, respectively (P<0.001). The 1-, 3-, and 5-year DFS rates were 78.46%, 63.68%, and 61.63% after LDLT, respectively, and 65.65%, 48.61%, and 41.87% after DDLT, respectively (P<0.001). The multivariate Cox regression model determined that the DFS and OS of HCC patients post-liver transplantation (LT) were strongly associated with tumour morphology and biology, but not graft type. CONCLUSIONS With regards to OS and DFS, there were no disadvantages to LDLT as compared with DDLT; tumour morphology and biology may affect the prognosis of LT.
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Affiliation(s)
- Zhenhua Hu
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China
| | - Ze Qian
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China
| | - Jian Wu
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China
| | - Jie Zhou
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China
| | - Min Zhang
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China
| | - Lin Zhou
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China
| | - Shusen Zheng
- Zhejiang University, School of Medicine, First Affiliated Hospital, Department of Hepatobiliary and Pancreatic Surgery, Hangzhou, China; Zhejiang University, School of Medicine, First Affiliated Hospital, Ministry of Public Health, Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou, China; Zhejiang University, College of Medicine, The First Affiliated Hospital, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 310003 Hangzhou, China.
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Nadalin S, Capobianco I, Panaro F, Di Francesco F, Troisi R, Sainz-Barriga M, Muiesan P, Königsrainer A, Testa G. Living donor liver transplantation in Europe. Hepatobiliary Surg Nutr 2016; 5:159-75. [PMID: 27115011 DOI: 10.3978/j.issn.2304-3881.2015.10.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Living donor liver transplantation (LDLT) sparked significant interest in Europe when the first reports of its success from USA and Asia were made public. Many transplant programs initiated LDLT and some of them especially in Germany and Belgium became a point of reference for many patients and important contributors to the advancement of the field. After the initial enthusiasm, most of the European programs stopped performing LDLT and today the overall European activity is concentrated in a few centers and the number of living donor liver transplants is only a single digit fraction of the overall number of liver transplants performed. In this paper we analyse the present European activities and highlight the European contribution to the advancement of the field of LDLT.
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Affiliation(s)
- Silvio Nadalin
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Ivan Capobianco
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Fabrizio Panaro
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Fabrizio Di Francesco
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Roberto Troisi
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Mauricio Sainz-Barriga
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Paolo Muiesan
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Alfred Königsrainer
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Giuliano Testa
- 1 Department of General and Transplant Surgery, University Hospital Tübingen, Germany ; 2 Department of General and Liver Transplant Surgery, Saint Eloi Hospital, University of Montpellier, Montpellier, France ; 3 Department of Paediatric Surgery and Transplantation Centre, Bambino Gesù Children's Hospital, Rome, Italy ; 4 Department of General, Hepato-Biliary and Transplantation Surgery, Gent University Hospital, Gent, Belgium ; 5 Department of HPB & Liver Transplant Surgery, CHU Tours University Hospital & Medical School Chambray-lès-Tours, France ; 6 Liver Surgery and Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK ; 7 Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, Dallas, TX, USA
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Ren J, Wu T, Zheng BW, Tan YY, Zheng RQ, Chen GH. Application of contrast-enhanced ultrasound after liver transplantation: Current status and perspectives. World J Gastroenterol 2016; 22:1607-1616. [PMID: 26819526 PMCID: PMC4721992 DOI: 10.3748/wjg.v22.i4.1607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/14/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation is an effective treatment for patients with end-stage liver disease. Accurate imaging evaluation of the transplanted patient is critical for ensuring that the limited donor liver is functioning appropriately. Ultrasound contrast agents (UCAs), in combination with contrast-specific imaging techniques, are increasingly accepted in clinical use for the assessment of the hepatic vasculature, bile ducts and liver parenchyma in pre-, intra- and post-transplant patients. We describe UCAs, their technical requirements, the recommended clinical indications, image interpretation and the limitations for contrast-enhanced ultrasound applications in liver transplantation.
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Di Sandro S, Slim AO, Giacomoni A, Lauterio A, Mangoni I, Aseni P, Pirotta V, Aldumour A, Mihaylov P, De Carlis L. Living donor liver transplantation for hepatocellular carcinoma: long-term results compared with deceased donor liver transplantation. Transplant Proc 2014; 41:1283-5. [PMID: 19460539 DOI: 10.1016/j.transproceed.2009.03.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Living donor liver transplantation (LDLT) may represent a valid therapeutic option allowing several advantages for patients affected by hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). However, some reports in the literature have demonstrated worse long-term and disease-free survivals among patients treated by LDLT than deceased donor liver transplantation (DDLT) for HCC. Herein we have reported our long-term results comparing LDLT with DDLT for HCC. PATIENTS AND METHODS Among 179 patients who underwent OLT from January 2000 to December 2007, 25 (13.9%) received LDLT with HCC 154 (86.1%) received DDLT. Patients were selected based on the Milan criteria. Transarterial chemoembolization, radiofrequency ablation, percutaneous alcoholization, or liver resection was applied as a downstaging procedure while on the waiting list. Patients with stage II HCC were proposed for LDLT. RESULTS The overall 3- and 5-year survival rates were 77.3% and 68.7% versus 82.8% and 76.7% for LDLT and DDLT recipients, respectively, with no significant difference by the log-rank test. Moreover, the 3- and 5-year recurrence-free survival rates were 95.5% and 95.5% (LDLT) versus 90.5% and 89.4% (DDLT; P = NS). CONCLUSIONS LDLT guarantees the same long-term results as DDLT where there are analogous selection criteria for candidates. The Milan criteria remain a valid tool to select candidates for LDLT to achieve optimal long-term results.
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Affiliation(s)
- S Di Sandro
- Department of Surgery and Abdominal Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
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Akamatsu N, Sugawara Y, Kokudo N. Living-donor vs deceased-donor liver transplantation for patients with hepatocellular carcinoma. World J Hepatol 2014; 6:626-631. [PMID: 25276278 PMCID: PMC4179141 DOI: 10.4254/wjh.v6.i9.626] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/21/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
With the increasing prevalence of living-donor liver transplantation (LDLT) for patients with hepatocellular carcinoma (HCC), some authors have reported a potential increase in the HCC recurrence rates among LDLT recipients compared to deceased-donor liver transplantation (DDLT) recipients. The aim of this review is to encompass current opinions and clinical reports regarding differences in the outcome, especially the recurrence of HCC, between LDLT and DDLT. While some studies report impaired recurrence - free survival and increased recurrence rates among LDLT recipients, others, including large database studies, report comparable recurrence - free survival and recurrence rates between LDLT and DDLT. Studies supporting the increased recurrence in LDLT have linked graft regeneration to tumor progression, but we found no association between graft regeneration/initial graft volume and tumor recurrence among our 125 consecutive LDLTs for HCC cases. In the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients, there is no evidence to support the higher HCC recurrence after LDLT than DDLT, and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.
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Role of liver transplantation for hepatocellular carcinoma. J Clin Exp Hepatol 2014; 4:S97-S103. [PMID: 25755618 PMCID: PMC4284221 DOI: 10.1016/j.jceh.2014.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/02/2014] [Indexed: 12/12/2022] Open
Abstract
This review evaluates the available evidence to establish the role of liver transplantation in the management of hepatocellular carcinoma in India. Most liver transplants in India are living donor transplants due to the paucity of brain dead organ donors. There is sufficient evidence to permit allocation of organs to patients with tumors within the Milan criteria. If the waiting list time is more than 6 months, a down-staging locoregional treatment modality such a trans-arterial chemoembolization, radiofrequency ablation, resection or percutaneous ethanol injection may be used to prevent disease progression. Allocating scarce livers to patients with more advanced tumors may not be justifiable. However, living donor liver transplantation may be offered to medically fit patients with hepatocellular carcinoma with cirrhosis, offering a guarded prognosis to patients beyond the Milan or UCSF criteria. Vascular invasion and extra-hepatic disease should be absolute contraindications to liver transplantation.
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Xu X, Guo HJ, Xie HY, Li J, Zhuang RZ, Ling Q, Zhou L, Wei XY, Liu ZK, Ding SM, Chen KJ, Xu ZY, Zheng SS. ZIP4, a novel determinant of tumor invasion in hepatocellular carcinoma, contributes to tumor recurrence after liver transplantation. Int J Biol Sci 2014; 10:245-56. [PMID: 24643086 PMCID: PMC3957080 DOI: 10.7150/ijbs.7401] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/21/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Recently, evidence that Zinc transporter ZRT/IRT-like protein 4 (ZIP4) is involved in invasiveness and apoptosis has emerged in pancreatic cancer and prostate cancer. Our aim was to assess the role of ZIP4 in invasiveness, migration and apoptosis of hepatocellular carcinoma (HCC). The prognostic value of ZIP4 in HCC after liver transplantation was evaluated. METHODS The role of ZIP4 in HCC was investigated by overexpressing ZIP4 in BEL7402 and HepG2 cells and inhibiting ZIP4 in HuH-7 and HepG2 cells, using overexpression and shRNA plasmids in vitro studies. Immunohistochemical analysis was used to evaluate ZIP4 expression in HCC tissues from 60 patients undergoing liver transplantation, 36 cirrhotic tissue samples, and 6 normal tissue samples. Prognostic significance was assessed using the Kaplan-Meier method and the log-rank test. RESULTS Specific suppression of ZIP4 reduced cell migration and invasiveness, whereas ZIP4 overexpression caused increases in cell migration and invasiveness. Furthermore, overexpression of ZIP4 resulted in increased expression of pro-metastatic genes (MMP-2, MMP-9) and decreased expression of pro-apoptotic genes (caspase-3, caspase-9, Bax). In contrast, suppression of ZIP4 resulted in an opposite effect. ZIP4 was more highly expressed in tumor tissues than non-tumor tissues (P < 0.0001). ZIP4 expression was significantly associated with tumor recurrence (P = 0.002), tumor node metastasis stage (P = 0.044), Child-Turcotte-Pugh score (P = 0.042), and tumor size (P = 0.022). Univariate analysis showed that ZIP4 expression was significantly associated with overall survival (P = 0.020) and tumor-free survival (P = 0.049). Multivariate analysis revealed that ZIP4 was an independent predictor of overall survival (P = 0.037) after liver transplantation. CONCLUSIONS ZIP4 could promote migration, invasiveness, and suppress apoptosis in hepatocellular carcinoma, and represent a novel predictor of poor prognosis and therapeutic target for patients with HCC who undergo liver transplantation.
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Affiliation(s)
- Xiao Xu
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 3. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hai-Jun Guo
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Hai-Yang Xie
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Jie Li
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Run-Zhou Zhuang
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Qi Ling
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Lin Zhou
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Xu-Yong Wei
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Zhi-Kun Liu
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Song-Ming Ding
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Kang-Jie Chen
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Zhi-Yuan Xu
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 2. Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health and Key Laboratory of Organ Transplantation of Zhejiang Province, Hangzhou, China
| | - Shu-Sen Zheng
- 1. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated, Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- 3. Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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12
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Chen H, Zhang Y, Han YM, Huguet E, Huang DS, Dong JH. Dual liver transplantation. J Zhejiang Univ Sci B 2013; 14:178-84. [PMID: 23463760 DOI: 10.1631/jzus.b1200041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care, and it is time-dependent. Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice. We need to improve upon the problems of low reperfusion rate, non-standardized treatment, and economic burden in STEMI care. This article briefly reviews the current status of reperfusion strategy in STEMI care, and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.
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Affiliation(s)
- Hao Chen
- Hepatobiliary Surgery Hospital and Institute of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
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13
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Liang W, Wu L, Ling X, Schroder PM, Ju W, Wang D, Shang Y, Kong Y, Guo Z, He X. Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma: a meta-analysis. Liver Transpl 2012; 18:1226-36. [PMID: 22685095 DOI: 10.1002/lt.23490] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Because of the severe organ shortage, living donor liver transplantation (LDLT) offers a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, the higher recurrence rate of HCC after LDLT and the indication criteria remain controversial. By conducting a quantitative meta-analysis, we sought to compare the survival outcomes and recurrence rates with LDLT and DDLT for patients with HCC. Comparative studies of LDLT and DDLT for HCC, which were identified by a comprehensive literature search, were included in this study. The evaluated outcomes included patient survival, recurrence-free survival (RFS), and recurrence rates at defined time points. Seven studies with a total of 1310 participants were included in this study. For LDLT and DDLT recipients, we found comparable patient survival rates [1 year, odds ratio (OR) = 1.03, 95% confidence interval (CI) = 0.62-1.73; 3 years, OR = 1.07, 95% CI = 0.77-1.48; and 5 years, OR = 0.64, 95% CI = 0.33-1.24] and RFS rates (1 year, OR = 0.86, 95% CI = 0.54-1.38; 3 years, OR = 1.04, 95% CI = 0.69-1.58; and 5 years, OR = 1.11, 95% CI = 0.70-1.77). Moreover, we found no significant differences in the 1-, 3-, or 5-year recurrence rates between LDLT and DDLT recipients (1 year, OR = 1.55, 95% CI = 0.36-6.58; 3 years, OR = 2.57, 95% CI = 0.53-12.41; and 5 years, OR = 1.21, 95% CI = 0.44-3.32). A subgroup analysis revealed similar outcomes for patients with HCC meeting the Milan criteria. These findings demonstrate that for HCC patients (especially those within the Milan criteria), LDLT represents an acceptable option that does not compromise patient survival or increase HCC recurrence in comparison with DDLT.
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Affiliation(s)
- Wenhua Liang
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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14
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Sandhu L, Sandroussi C, Guba M, Selzner M, Ghanekar A, Cattral MS, McGilvray ID, Levy G, Greig PD, Renner EL, Grant DR. Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma: comparable survival and recurrence. Liver Transpl 2012; 18:315-22. [PMID: 22140013 DOI: 10.1002/lt.22477] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several studies have reported higher rates of recurrent hepatocellular carcinoma (HCC) after living donor liver transplantation (LDLT) versus deceased donor liver transplantation (DDLT). It is unclear whether this difference is due to a specific biological effect unique to the LDLT procedure or to other factors such as patient selection. We compared the overall survival (OS) rates and the rates of HCC recurrence after LDLT and DDLT at our center. Between January 1996 and September 2009, 345 patients with HCC were identified: 287 (83%) had DDLT and 58 (17%) had LDLT. The OS rates were calculated with the Kaplan-Meier method, whereas competing risks methods were used to determine the HCC recurrence rates. The LDLT and DDLT groups were similar with respect to most clinical parameters, but they had different median waiting times (3.1 versus 5.3 months, P = 0.003) and median follow-up times (30 versus 38.1 months, P = 0.02). The type of transplant did not affect any of the measured cancer outcomes. The OS rates at 1, 3, and 5 years were equivalent: 91.3%, 75.2%, and 75.2%, respectively, for the LDLT group and 90.5%, 79.7%, and 74.6%, respectively, for DDLT (P = 0.62). The 1-, 3-, and 5-year HCC recurrence rates were also similar: 8.8%, 10.7%, and 15.4%, respectively, for the LDLT group and 7.5%, 14.8%, and 17.0%, respectively, for the DDLT group (P = 0.54). A regression analysis identified microvascular invasion (but not the graft type) as a predictor of HCC recurrence. In conclusion, in well-matched cohorts of LDLT and DDLT recipients, LDLT and DDLT provide similarly low recurrence rates and high survival rates for the treatment of HCC.
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Affiliation(s)
- Lakhbir Sandhu
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada
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15
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Greig PD, Geier A, D'Alessandro AM, Campbell M, Wright L. Should we perform deceased donor liver transplantation after living donor liver transplantation has failed? Liver Transpl 2011; 17 Suppl 2:S139-46. [PMID: 21563294 DOI: 10.1002/lt.22328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Paul D Greig
- University of Toronto, Toronto, Ontario, Canada.
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16
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Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, Mariani L. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transpl 2011; 17 Suppl 2:S44-57. [PMID: 21695773 DOI: 10.1002/lt.22365] [Citation(s) in RCA: 411] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Vincenzo Mazzaferro
- Units of Gastrointestinal Surgery and Liver Transplantation, National Cancer Institute of Milan, Milan, Italy.
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17
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Balci D, Dayangac M, Yaprak O, Akin B, Duran C, Killi R, Yuzer Y, Tokat Y. Living donor liver transplantation for hepatocellular carcinoma: a single center analysis of outcomes and impact of different selection criteria. Transpl Int 2011; 24:1075-83. [DOI: 10.1111/j.1432-2277.2011.01311.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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18
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Silva MF, Wigg AJ. Current controversies surrounding liver transplantation for hepatocellular carcinoma. J Gastroenterol Hepatol 2010; 25:1217-26. [PMID: 20594247 DOI: 10.1111/j.1440-1746.2010.06335.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver transplantation (LT) for hepatocellular carcinoma (HCC) has progressed rapidly over the last decade from a futile therapy to the first choice therapy for suitable patients. Excellent outcomes of LT for HCC can be largely attributed to the use of the Milan Criteria, which have restricted LT to patients with early stage tumors. These criteria may be conservative, and it is likely that a subset of patients with tumors beyond these criteria can have acceptable outcomes. However, there is currently insufficient data to accept more liberal criteria as a standard of care, and a higher quality evidence base must be achieved to prevent poor utilization of valuable donor liver resources. In the future, it is probable that more sophisticated selection criteria will emerge incorporating aspects of tumor biology beyond tumor size and number. Dropout from the waiting list due to tumor progression remains a clinical challenge particularly in regions with prolonged waiting times. Priority allocation using HCC MELD points is a practical and transparent solution that has successfully reduced waitlist dropout for HCC patients. Further refinements of the HCC MELD point system are required to ensure equity of access to LT for non-HCC patients and prioritization of HCC patients with the highest risk of dropout. Improving the evidence base for pre-LT locoregional therapy to prevent waitlist dropout is an urgent and difficult challenge for the LT community. In the interim transplant clinicians must restrict the use of these therapies to those patients who are most likely to benefit from them.
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Affiliation(s)
- Mauricio F Silva
- Department of Gastroenterology and Hepatology, Flinders University, Adelaide, Australia.
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19
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Piscaglia F, Gianstefani A, Ravaioli M, Golfieri R, Cappelli A, Giampalma E, Sagrini E, Imbriaco G, Pinna AD, Bolondi L. Criteria for diagnosing benign portal vein thrombosis in the assessment of patients with cirrhosis and hepatocellular carcinoma for liver transplantation. Liver Transpl 2010; 16:658-67. [PMID: 20440775 DOI: 10.1002/lt.22044] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Malignant portal vein thrombosis is a contraindication for liver transplantation. Patients with cirrhosis and early hepatocellular carcinoma (HCC) may have either malignant or benign (fibrin clot) portal vein thrombosis. The aim of this study was to assess prospectively whether well-defined diagnostic criteria would enable the nature of portal vein thrombosis to be established in patients with HCC under consideration for liver transplantation. Benign portal vein thrombosis was diagnosed by the application of the following criteria: lack of vascularization of the thrombus on contrast-enhanced ultrasound and on computed tomography or magnetic resonance imaging, absence of mass-forming features of the thrombus, absence of disruption of the walls of veins, and, if uncertainty persisted, biopsy of the thrombus for histological examination. Patients who did not fulfill the criteria for benign thrombosis were not placed on the transplantation list. In this study, all patients evaluated at our center during 2001-2007 with a diagnosis of HCC in whom portal vein thrombosis was concurrently or subsequently diagnosed were discussed by a multidisciplinary group to determine their suitability for liver transplantation. The outcomes for 33 patients who met the entry criteria of the study were as follows: in 14 patients who were placed on the transplantation list and underwent liver transplantation, no malignant thrombosis was detected when liver explants were examined histologically; 5 patients who were placed on the transplantation list either remained on the list or died from causes unrelated to HCC; in 9 patients, liver transplantation was contraindicated on account of a strong suspicion, or confirmation, of the presence of malignant portal vein thrombosis; and 5 patients who were initially placed on the transplantation list were subsequently removed from it on account of progression of HCC in the absence of evidence of neoplastic involvement of thrombosis. In conclusion, for a patient with HCC and portal vein thrombosis, appropriate investigations can establish whether the thrombosis is benign; patients with HCC and benign portal vein thrombosis are candidates for liver transplantation.
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Affiliation(s)
- Fabio Piscaglia
- Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, St. Orsola-Malpighi University Hospital, Bologna, Italy.
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20
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Mergental H, Porte RJ. Liver transplantation for unresectable hepatocellular carcinoma in patients without liver cirrhosis. Transpl Int 2010; 23:662-7. [PMID: 20345561 DOI: 10.1111/j.1432-2277.2010.01076.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) arising in noncirrhotic and nonfibrotic liver (NC-HCC) is a rare type of malignancy frequently found in healthy young individuals. Partial liver resection is the treatment of choice with expected 5-year survival rates between 40% and 70%. As a result of absence of any symptom, a considerable number of patients are diagnosed when the malignancy has progressed to an advanced stage and the tumor has turned already unresectable. Some other patients suffer from intrahepatic recurrence after previous liver resection that cannot be re-resected or locally ablated. In these situations, liver transplantation (LT) may be the only potentially curative treatment. The indication for LT in NC-HCC patients, however, is not well established. The preliminary results of recent analysis of the European Liver Transplant Registry (ELTR) together with a literature review identified over 150 patients transplanted for NC-HCC during the last 15 years. In contrast to the historical data, these studies showed 5-year survival rates at 50-70% in well-selected patients. Important determinants of poor outcome are macrovascular invasion, lymph node involvement, and time interval of <12 months when LT is used as rescue therapy for intrahepatic recurrence after a previous partial liver resection. Interestingly, outcomes after both liver resection and LT for NC-HCC are much less influenced by tumor size than is the case with cirrhotic HCC. A large tumor size per se should, therefore, not to be seen as a strict contraindication for performing LT in patients with NC-HCC.
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Affiliation(s)
- Hynek Mergental
- Oxford Transplant Centre and Department of Hepato-Pancreato-Biliary Surgery, Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital, Oxford, UK
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Morris-Stiff G, Gomez D, de Liguori Carino N, Prasad K. Surgical management of hepatocellular carcinoma: Is the jury still out? Surg Oncol 2009; 18:298-321. [DOI: 10.1016/j.suronc.2008.08.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/19/2008] [Indexed: 02/07/2023]
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Liver transplantation, liver resection, and transarterial chemoembolization for hepatocellular carcinoma in cirrhosis: which is the best oncological approach? Dig Dis Sci 2009; 54:2264-73. [PMID: 19057997 DOI: 10.1007/s10620-008-0604-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 10/24/2008] [Indexed: 01/17/2023]
Abstract
The aim of the study was to evaluate our institutional experience with monotherapies for hepatocellular carcinoma (HCC) in the setting of cirrhosis. A retrospective cohort study was carried out at the tertiary care academic referral center and involved 185 consecutive HCC patients with cirrhosis and no previous treatment who underwent resection (n = 61), transarterial chemoembolization (TACE) (n = 64), or liver transplantation (LT) (n = 60). Long-term survival and survival according to the Milan criteria were the main outcomes measured. Median survival after resection, TACE, and LT was 11, 14, and 23 months, respectively. Five-year cumulative survival after resection, TACE, and LT was 23, 10, and 59%, respectively (P = 0.001). Five-year cumulative disease-free survival after resection and LT was 15% and 77%, respectively (P = 0.002). The presence of complications in the resection group (P = 0.004), MELD score (P = 0.0003), and maximum tumor diameter (P = 0.05) in the TACE group, and tumor grade (P = 0.01) and complications (P = 0.004) in the LT group were found to be independent predictors of survival. Five-year survival for patients within the Milan criteria after resection, TACE, and LT was 26, 37, and 66%, respectively. Five-year survival for patients outside the Milan criteria for patients undergoing LT was 53%. The results suggest that LT represents the best oncological treatment option for patients with HCC in the setting of cirrhosis, even for those beyond the Milan criteria. Considering the scarcity of available organs, liver resection remains the best alternative option. TACE remains a potential therapy in patients within the Milan criteria, where it may be more beneficial than resection.
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Liberal policy in living donor liver transplantation for hepatocellular carcinoma: lessons learned. Dig Dis Sci 2009; 54:377-84. [PMID: 18594985 DOI: 10.1007/s10620-008-0319-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 05/06/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) in cases of hepatocellular carcinoma (HCC) that do not fulfil accepted tumor criteria continues to be a matter of controversy. The aim of this study was to evaluate survival and prognostic factors associated with a liberal exclusionary policy. MATERIAL AND METHODS This is an analysis of data collected prospectively on 57 HCC patients who underwent LDLT at our institution between April 1998 and January 2007. RESULTS Overall 3-year survival was 62%; this increased to 71% when 45-day mortality was excluded from the analysis. Age proved to be a predictor of survival irrespective of the 45-day mortality. In contrast, the Model for End stage Liver Disease (MELD) score predicted survival only when 45-day mortality was included in the analysis, while alpha fetoprotein (AFP) level predicted survival only when it was excluded. Significant cut-off values were patient age of over 60 years, MELD score above 22, and AFP level greater than 400 ng/ml. A scoring system was developed. Survival rate at 3 years--including 45-day mortality--was 72% for score =2 and 41% for score >2 (P = 0.0146). When 45-day mortality was excluded, the survival rate at 3 years was 90% for score =2 and 32% for score >2 (P = 0.00002). CONCLUSIONS Our results could further enhance current guidelines on age, MELD score, and AFP level for patients with HCC being evaluated to undergo LDLT.
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24
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Bo W, Yan L. The Difference and the Transition of Indication for Adult Living Donor Liver Transplantation Between the West and the East. Transplant Proc 2008; 40:3507-11. [DOI: 10.1016/j.transproceed.2008.06.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 04/17/2008] [Accepted: 06/16/2008] [Indexed: 02/07/2023]
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25
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Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, Vivarelli M, Golfieri R, D'Errico Grigioni A, Panzini I, Morelli C, Bernardi M, Bolondi L, Pinna AD. Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 2008; 8:2547-57. [PMID: 19032223 DOI: 10.1111/j.1600-6143.2008.02409.x] [Citation(s) in RCA: 284] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Conventional criteria for liver transplantation for patients with hepatocellular carcinoma are single HCC <or= 5 cm or less than or equal to three HCCs <or= 3 cm. We prospectively evaluated the possibility of slightly extending these criteria in a down-staging protocol, which included patients initially outside conventional criteria: single HCC 5-6 cm or two HCCs <or= 5 cm or less than six HCCs <or= 4 cm and sum diameter <or= 12 cm, but within Milan criteria in the active tumors after the down-staging procedures. The outcome of patients down-staged was compared to that of Milan criteria after liver transplantation and since the first evaluation according to an intention-to-treat principle. From 2003 to 2006, 177 patients with HCC were considered for transplantation: the transplantation rate was comparable between the Milan and down-staging groups: 88/129 cases (68%) versus 32/48 cases (67%), respectively. At a median follow-up of 2.5 years after transplantation, the 1 and 3 years' disease-free survival rates were comparable: 80% and 71% in the Milan group versus 78% and 71% in the down-staging. The actuarial intention-to-treat survival was 27/48 patients (56.3%) in the down-staging and 81/129 cases (62.8%) in the Milan group, p = n.s. The proposed down-staging criteria provide a comparable outcome to the conventional criteria.
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Affiliation(s)
- M Ravaioli
- Department of Liver and Multi-organ Transplantation, Pathology Division of the F. Addarii Institute, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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26
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Fouzas I, Sotiropoulos G, Molmenti E, Beckebaum S, Schmitz K, Broelsch C, Lang H, Malagó M. “Preemptive” Live Donor Liver Transplantation for Fibrolamellar Hepatocellular Carcinoma: A Case Report. Transplant Proc 2008; 40:3806-7. [DOI: 10.1016/j.transproceed.2008.09.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
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Living Donor Liver Transplantation for Hepatocellular Carcinoma in Patients Exceeding the UCSF Criteria. Transplant Proc 2008; 40:3185-8. [DOI: 10.1016/j.transproceed.2008.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sotiropoulos GC, Kuehl H, Sgourakis G, Molmenti EP, Beckebaum S, Cicinnati VR, Baba HA, Schmitz KJ, Broelsch CE, Lang H. Pulmonary nodules at risk in patients undergoing liver transplantation for hepatocellular carcinoma. Transpl Int 2008; 21:850-6. [DOI: 10.1111/j.1432-2277.2008.00688.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sotiropoulos GC, Radtke A, Schmitz KJ, Molmenti EP, Schroeder T, Saner FH, Baba HA, Fouzas I, Broelsch CE, Malagó M, Lang H. Liver transplantation in the setting of hepatocellular carcinoma and portal vein thrombosis: a challenging dilemma? Dig Dis Sci 2008; 53:1994-9. [PMID: 18080191 DOI: 10.1007/s10620-007-0099-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 10/27/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) represents a potentially unfavorable prognostic factor in liver transplantation (LT) for hepatocellular carcinoma (HCC). However, it is frequently difficult to establish preoperatively whether the thrombus is associated with tumor invasion or with stagnant flow. The purpose of this study was to further address this controversial issue. PATIENTS AND METHODS We evaluated 12 consecutive patients who underwent liver transplantation for HCC in the setting of PVT. RESULTS The origin of PVT in HCC patients could be accurately evaluated in 58% of the patients. Forty-two percent of patients had no evident portal vein invasion and only 17% of cases had tumor thrombi. One-third of patients experienced tumor recurrence within the first posttransplant year, and one-third of patients became long-term survivors (median survival of 36 months) with no evidence of tumor recurrence. One-year survival was 92%. Nine patients are currently alive after a median follow-up period of 25 months. CONCLUSIONS PVT in the setting of HCC is characterized by poor patient outcome. However, a respectable number of instances are not accurately evaluated preoperatively, making the decision to exclude these patients from LT sometimes a challenging dilemma.
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Affiliation(s)
- Georgios C Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, Essen 45122, Germany.
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Baccarani U, Isola M, Adani GL, Benzoni E, Avellini C, Lorenzin D, Bresadola F, Uzzau A, Risaliti A, Beltrami AP, Soldano F, De Anna D, Bresadola V. Superiority of transplantation versus resection for the treatment of small hepatocellular carcinoma. Transpl Int 2008; 21:247-54. [DOI: 10.1111/j.1432-2277.2007.00597.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Hepatic surgery has made substantial advances in the last two decades due to technical developments and improvements in perioperative management. This has reduced surgery dependent mortality to less than 5%, and provides the possibility of carrying out more substantial hepatic resections and to interpret the indications more liberally, also for tumours localized unfavorably. A widely standardized surgical technique as well as new possibilities for organ conservation and, in particular, immunosuppression mean that given suitable indications, liver transplantation is today regarded as a routine procedure for the treatment of hepatocellular carcinoma. This work provides an overview of the current status of surgical therapy for the most frequent, benign liver tumours, as well as for hepatocellular and cholangiocellular carcinoma.
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Affiliation(s)
- H Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, 45122, Hufelandstrasse 55, Essen, Germany.
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Ito T, Takada Y, Ueda M, Haga H, Maetani Y, Oike F, Ogawa K, Sakamoto S, Ogura Y, Egawa H, Tanaka K, Uemoto S. Expansion of selection criteria for patients with hepatocellular carcinoma in living donor liver transplantation. Liver Transpl 2007; 13:1637-44. [PMID: 18044766 DOI: 10.1002/lt.21281] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the present study, the results of living donor liver transplantation (LDLT) for 125 hepatocellular carcinoma (HCC) patients were analyzed to determine optimal criteria exceeding the Milan criteria (MC) but still with predictably good outcomes. On the basis of pretransplant imaging studies, 70 patients met the MC, and 55 patients did not. Patients who exceeded the MC but presented with <or=10 tumors all<or=5 cm in diameter (n=30) displayed 5-year recurrence rates (7.3%) similar to those of patients within the MC (9.7%, P=0.8787). According to the results of multivariate analysis of risk factors for recurrence among preoperative tumor variables, we have defined the new criteria, namely <or=10 tumors all<or=5 cm in diameter and protein induced by vitamin K absence or antagonist-II (PIVKA-II)<or=400 mAU/mL. The 78 patients who met the new criteria showed significantly lower 5-year recurrence rates (4.9%) than the 40 patients who exceeded them (60.5%, P<0.0001). Similarly, 5-year survival rates significantly differed between these groups (86.7% versus 34.4%, respectively; P<0.0001). In conclusion, selection criteria for patients with HCC undergoing LDLT may be safely extended to <or=10 tumors all<or=5 cm in diameter and PIVKA-II<or=400 mAU/mL with acceptable outcomes.
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Affiliation(s)
- Takashi Ito
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Liver Transplantation for Hepatocellular Carcinoma: University Hospital Essen Experience and Metaanalysis of Prognostic Factors. J Am Coll Surg 2007; 205:661-75. [DOI: 10.1016/j.jamcollsurg.2007.05.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Accepted: 05/22/2007] [Indexed: 12/13/2022]
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Sotiropoulos GC, Treckmann JW, Molmenti EP, Schmitz KJ, Cicinnati VR, Paul A, Broelsch CE, Malagó M. Salvage live donor liver transplantation for a second recurrence of hepatocellular carcinoma. Transpl Int 2007; 21:182-5. [PMID: 17971034 DOI: 10.1111/j.1432-2277.2007.00572.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hwang S, Lee SG, Ahn CS, Kim KH, Moon DB, Ha TY, Park KM, Song GW, Jung DH, Kim BS, Moon KM. Small-sized liver graft does not increase the risk of hepatocellular carcinoma recurrence after living donor liver transplantation. Transplant Proc 2007; 39:1526-9. [PMID: 17580180 DOI: 10.1016/j.transproceed.2007.03.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 03/20/2007] [Indexed: 01/11/2023]
Abstract
PURPOSE Following implantation into adult recipients, living donor liver grafts usually undergo liver regeneration. This regeneration process may provoke the growth of occult hepatocellular carcinoma (HCC) cells in the recipient body. To assess the risk of HCC recurrence, we analyzed the influence of graft-recipient weight ratio (GRWR). METHODS The 181 recipients with HCC within the University of California at San Francisco (UCSF) criteria were divided into four groups according to GRWR: low GRWR (<0.8; n = 30), mid GRWR (0.8-1.0; n = 65), high GRWR (>1.0; n = 64), and whole liver graft group (>1.5; n = 22). RESULTS There were no differences in overall patient survival (P = .105) and recurrence-free survival (P = .406) among these four groups. GRWR <0.8 was not a significant risk factor for HCC recurrence. Similar outcomes were obtained in HCC patients who met the Milan criteria (n = 170). CONCLUSIONS We think that small living donor liver graft and subsequent liver regeneration do not increase the risk of posttransplant HCC recurrence when HCC is within the Milan or UCSF criteria.
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Affiliation(s)
- S Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Seoul 138-736, Republic of Korea
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Sotiropoulos GC, Beckebaum S, Lang H, Frilling A, Molmenti EP, Cicinnati VR, Saner FH, Erim Y, Baba HA, Malagó M, Broelsch CE. Single-center experience on liver transplantation for hepatocellular carcinoma arising in alcoholic cirrhosis: results and ethical issues. Eur Surg Res 2007; 40:7-13. [PMID: 17717419 DOI: 10.1159/000107615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 05/16/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Liver transplantation is currently recognized as the optimal treatment for both early hepatocellular carcinoma in the setting of cirrhosis (HCC) as well as for alcoholic liver disease (ALD). The purpose of this study was to evaluate the outcome of patients with HCC and ALD in the absence of viral hepatitic infections. METHODS Twelve recipients were transplanted with a diagnosis of HCC and ALD in the absence of viral hepatitis during a 6-year period. Nine received deceased donor livers, and 3 live donor grafts. Our results were compared to those obtained by a search of the world literature. RESULTS The postoperative course was uneventful in all but one patient. All recipients experienced a good quality of life postoperatively. Three-year overall and recurrence-free survival rates were 82 and 73%, respectively. Nine patients are currently alive, after a median follow-up of 29 months. CONCLUSION This is the first study to evaluate liver transplantation for HCC in ALD. Although outcomes are excellent, the evaluation of patients with ALD and HCC constitutes a challenging topic in transplantation surgery, especially when live liver donation is considered. An interdisciplinary structured approach is recommended, with special emphasis on ethical considerations.
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Affiliation(s)
- G C Sotiropoulos
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany.
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Abstract
PURPOSE OF REVIEW This review primarily focuses on new developments in the prevention and treatment of hepatocellular carcinoma. RECENT FINDINGS Molecular markers for tumor biology are still in development, but advances thus far are promising. The Barcelona Clinic Liver Cancer (BCLC) staging system offers the best prognostic information in patients with hepatocellular carcinoma. While surgery remains the gold standard for the treatment of hepatocellular carcinoma, new methods are emerging with greater potential response, lower risk and lower cost. Percutaneous local ablative therapy has proved very effective. Chemoemobolization therapy in hepatocellular carcinoma has been effective in selected patients with improved survival reported in a large cohort. SUMMARY New methods for the management of hepatocellular carcinoma need to continue to evolve. This includes more focused therapies to reduce tumor development or more effective adjuvants to promote positive pre and posttransplant response. With the advent of better treatment options due to a clearer understanding of the pathogenesis of hepatocellular carcinoma, there is hope that the seemingly insurmountable burden of this disease will come under better control.
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Affiliation(s)
- Laura M Kulik
- Division of Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Schmeding M, Neumann UP, Puhl G, Bahra M, Neuhaus R, Neuhaus P. Hepatitis C recurrence and fibrosis progression are not increased after living donor liver transplantation: a single-center study of 289 patients. Liver Transpl 2007; 13:687-92. [PMID: 17457911 DOI: 10.1002/lt.21138] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Today, hepatitis C virus (HCV) is the leading cause for liver transplantation (LT) and viral recurrence is almost universal. It has been suggested that viral replication within the transplanted tissue might be increased in organs of reduced size such as LD grafts. In the current literature the data is controversial, with many studies lacking routine liver biopsies. We performed a retrospective analysis of 289 HCV-LT (20 LD splits) patients receiving transplants between 1997 and 2005. Patient and organ survival, intensity of HCV recurrence, and fibrosis progression were analyzed with respect to deceased donor (DD) LT (DDLT) or living donor (LD) LT (LDLT). Organ and patient survival was significantly better for full-size recipients than for split-liver patients, with P = 0.037 for organ survival and P = 0.037 for patient survival; yet there were no significant differences when split-liver patients with large hepatocellular carcinoma (HCC) beyond the Milan criteria (n = 3) were excluded from the analysis (P > 0.05). First year fibrosis progression was 1.29 in full-size grafts and 1.07 in split-livers (P = not significant). In conclusion, in our patient sample, intensity of HCV recurrence was not increased in LD graft recipients compared to full-size recipients. Patient and organ survival were similar when patients with large HCC and early tumor recurrence were excluded from analysis. LDLT can therefore be advocated for HCV patients.
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Affiliation(s)
- Maximilian Schmeding
- Department of General and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany.
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Nadalin S, Malagò M, Radtke A, Erim Y, Saner F, Valentin-Gamazo C, Schröder T, Schaffer R, Sotiropoulos GC, Li J, Frilling A, Broelsch CE. Current trends in live liver donation. Transpl Int 2007; 20:312-30. [PMID: 17326772 DOI: 10.1111/j.1432-2277.2006.00424.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The introduction of living donor liver transplantation (LDLT) has been one of the most remarkable steps in the field of liver transplantation (LT), able to significantly expand the scarce donor pool in countries in which the growing demands of organs are not met by the shortage of available cadaveric grafts. Although the benefits of this procedure are enormous, the physical and psychological sacrifice of the donors is immense, and the expectations for a good outcome for themselves, as well as for the recipients, are high. We report a current overview of the latest trends in live liver donation in its different aspects (i.e. donor's selection, evaluation, operation, morbidity, mortality, ethics and psychology). This review is based on our center's personal experience with almost 200 LDLTs and a detailed analysis of the international literature of the last 7 years about this topic. Knowing in detail how to approach to the different aspects of living liver donation may be helpful in further improve donor's safety and even recipient's outcome.
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Affiliation(s)
- Silvio Nadalin
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
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Hong Z, Wu J, Smart G, Kaita K, Wen SW, Paton S, Dawood M. Survival analysis of liver transplant patients in Canada 1997-2002. Transplant Proc 2007; 38:2951-6. [PMID: 17112872 DOI: 10.1016/j.transproceed.2006.08.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Indexed: 01/05/2023]
Abstract
UNLABELLED Liver transplantation is an important health care issue for Canadians. Very few studies have assessed survival and determinants of survival in liver transplant patients in Canada. METHODS We carried out an epidemiological analysis of 1 year survival and determinants of 1 year survival in liver transplant patients, using Canadian Organ Replacement Registry data (1997-2002). Survival curves were plotted by the Kaplan-Meier method. Cox proportional hazards analysis was applied to evaluate hazard ratios with different age groups, gender, ethnicity, blood groups, donor type, pretransplantation medical status, and HBV infection status. RESULTS A total of 1164 liver transplant patients were included in the analysis. One-year survival rate was 84.7%. Male recipients had a 21% higher risk of developing organ failure than females. Recipients over 60 years of age had a 5% lower survival probability in comparison with recipients below 20 years of age. Pacific Islanders and Aboriginals had 32% and 9% lower survival probabilities, respectively, in comparison with Caucasians. Type B blood recipients had a 12% higher survival probability, whereas type AB blood recipients had a 7% lower survival probability compared with type O blood recipients. Twenty-six live organ recipients had 40% higher survival probabilities than 1138 cadaveric organ recipients. Patients with fulminant hepatitis (status 3F) had the highest survival, while patients with fulminant failure in ICU with intubation/ventilation (status 4F) had the lowest survival. One hundred sixty-seven recipients with positive HBsAg antigen showed 10% lower survival probability than 997 cases with negative HBsAg antigen. CONCLUSION In Canada, the first year survival rate is about 85%, which is comparable with other industrialized countries. Type of donor organs and recipient gender, ethnicity, ABO blood group, pretransplantation medical status, and HBV infection status had significant affects on the recipient survival.
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Affiliation(s)
- Z Hong
- Blood Safety Surveillance and Health Care Acquired Infection Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario.
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Volk ML, Marrero JA, Lok AS, Ubel PA. Who decides? Living donor liver transplantation for advanced hepatocellular carcinoma. Transplantation 2007; 82:1136-9. [PMID: 17102762 DOI: 10.1097/01.tp.0000245670.75583.3d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Few effective treatment options are available for patients with advanced hepatocellular carcinoma (HCC). Some transplant centers have begun offering living donor liver transplantation (LDLT) for selected patients whose HCC exceeds Milan criteria by a small margin. However, this remains a controversial subject. In this article, we weigh the arguments for and against LDLT for advanced HCC. Because donor autonomy forms the crux of this dilemma, the real question becomes: to whom does the decision belong, the individual donors or the medical community? We argue that donor autonomy should not be paramount in settings where the recipient benefit is uncertain.
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Affiliation(s)
- Michael L Volk
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109-0362, USA.
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42
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Sotiropoulos GC, Frilling A, Molmenti EP, Brokalaki EI, Beckebaum S, Omar OS, Broelsch CE, Malagó M. De novo hepatocellular carcinoma in recurrent liver cirrhosis after liver transplantation for benign hepatic disease: is a deceased donor re-transplantation justified? Transplantation 2006; 82:1112. [PMID: 17060864 DOI: 10.1097/01.tp.0000230283.84633.4a] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Varela M, Forner A, Bruix J. Diagnosis and staging of hepatocellular carcinoma prior to transplantation: expertise or failure. Liver Transpl 2006; 12:1445-7. [PMID: 17004255 DOI: 10.1002/lt.20909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Majno P, Mazzaferro V. Living donor liver transplantation for hepatocellular carcinoma exceeding conventional criteria: questions, answers and demands for a common language. Liver Transpl 2006; 12:896-8. [PMID: 16721768 DOI: 10.1002/lt.20808] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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