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Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma
BACKGROUND: The strategy of salvage liver transplantation (SLT) originated for initially resectable and transplantable hepatocellular carcinoma (HCC) to preclude upfront transplantation, with SLT in the case of recurrence. However, SLT remains a controversial approach in comparison to primary liver...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248033/ https://www.ncbi.nlm.nih.gov/pubmed/30072683 http://dx.doi.org/10.12659/AOT.908623 |
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author | Yadav, Dipesh Kumar Chen, Wei Bai, Xueli Singh, Alina Li, Guogang Ma, Tao Yu, Xiazhen Xiao, Zhi Huang, Bingfeng Liang, Tingbo |
author_facet | Yadav, Dipesh Kumar Chen, Wei Bai, Xueli Singh, Alina Li, Guogang Ma, Tao Yu, Xiazhen Xiao, Zhi Huang, Bingfeng Liang, Tingbo |
author_sort | Yadav, Dipesh Kumar |
collection | PubMed |
description | BACKGROUND: The strategy of salvage liver transplantation (SLT) originated for initially resectable and transplantable hepatocellular carcinoma (HCC) to preclude upfront transplantation, with SLT in the case of recurrence. However, SLT remains a controversial approach in comparison to primary liver transplant (PLT). The aim of our study was to conduct a systemic review and meta-analysis to assess the short-term outcomes, overall survival (OS), and disease-free survival (DFS) between SLT and PLT for patients with HCC, stratifying results according to the Milan criteria and donor types. MATERIAL/METHODS: A search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing SLT and PLT. A fixed effects model and a random effects model meta-analysis were conducted to assess the short-term outcomes, OS, and DFS based on the evaluation of heterogeneity. RESULTS: SLT had superior 1-year, 3-year, and 5-year OS and DFS compared with that of PLT. After classifying data according to donor type and Milan criteria, our meta-analysis revealed: that for deceased-donor liver transplantation (DDLT) recipients, there were no significant differences in 1-year and 3-year OS rate between the SLT group and the PLT group. However, the 5-year OS rate was superior in the SLT group compared to the PLT group. Similarly, SLT had superior 1-year, 3-year, and 5-year OS rate compared to PLT in living-donor liver transplantation (LDLT) recipients. Moreover, 1-year, 3-year, and 5-year DFS were also superior in SLT compared to PLT in both the DDLT and LDLT recipients. In patients within Milan criteria there were no statistically significant differences in 1-year, 3-year, and 5-year OS and DFS between the SLT group and the PLT group. Similarly, in patients beyond Milan criteria, both SLT and PLT showed no significant difference for 1-year, 3-year, and 5-year OS rate. CONCLUSIONS: Our meta-analysis included the largest number of studies comparing SLT and PLT, and SLT was found to have significantly better OS and DFS. Moreover, this meta-analysis suggests that SLT has comparable postoperative complications to that of PLT, and thus, SLT may be a better treatment strategy for recurrent HCC patients and patients with compensated liver, whenever feasible, considering the severe organ limitation and the safety of SLT. However, PLT can be referred as a treatment strategy for HCC patients with cirrhotic and decompensated liver. |
format | Online Article Text |
id | pubmed-6248033 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-62480332018-11-28 Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma Yadav, Dipesh Kumar Chen, Wei Bai, Xueli Singh, Alina Li, Guogang Ma, Tao Yu, Xiazhen Xiao, Zhi Huang, Bingfeng Liang, Tingbo Ann Transplant Meta-Analysis BACKGROUND: The strategy of salvage liver transplantation (SLT) originated for initially resectable and transplantable hepatocellular carcinoma (HCC) to preclude upfront transplantation, with SLT in the case of recurrence. However, SLT remains a controversial approach in comparison to primary liver transplant (PLT). The aim of our study was to conduct a systemic review and meta-analysis to assess the short-term outcomes, overall survival (OS), and disease-free survival (DFS) between SLT and PLT for patients with HCC, stratifying results according to the Milan criteria and donor types. MATERIAL/METHODS: A search of PubMed, EMBASE, and the Cochrane Library was conducted to identify studies comparing SLT and PLT. A fixed effects model and a random effects model meta-analysis were conducted to assess the short-term outcomes, OS, and DFS based on the evaluation of heterogeneity. RESULTS: SLT had superior 1-year, 3-year, and 5-year OS and DFS compared with that of PLT. After classifying data according to donor type and Milan criteria, our meta-analysis revealed: that for deceased-donor liver transplantation (DDLT) recipients, there were no significant differences in 1-year and 3-year OS rate between the SLT group and the PLT group. However, the 5-year OS rate was superior in the SLT group compared to the PLT group. Similarly, SLT had superior 1-year, 3-year, and 5-year OS rate compared to PLT in living-donor liver transplantation (LDLT) recipients. Moreover, 1-year, 3-year, and 5-year DFS were also superior in SLT compared to PLT in both the DDLT and LDLT recipients. In patients within Milan criteria there were no statistically significant differences in 1-year, 3-year, and 5-year OS and DFS between the SLT group and the PLT group. Similarly, in patients beyond Milan criteria, both SLT and PLT showed no significant difference for 1-year, 3-year, and 5-year OS rate. CONCLUSIONS: Our meta-analysis included the largest number of studies comparing SLT and PLT, and SLT was found to have significantly better OS and DFS. Moreover, this meta-analysis suggests that SLT has comparable postoperative complications to that of PLT, and thus, SLT may be a better treatment strategy for recurrent HCC patients and patients with compensated liver, whenever feasible, considering the severe organ limitation and the safety of SLT. However, PLT can be referred as a treatment strategy for HCC patients with cirrhotic and decompensated liver. International Scientific Literature, Inc. 2018-08-03 /pmc/articles/PMC6248033/ /pubmed/30072683 http://dx.doi.org/10.12659/AOT.908623 Text en © Ann Transplant, 2018 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Meta-Analysis Yadav, Dipesh Kumar Chen, Wei Bai, Xueli Singh, Alina Li, Guogang Ma, Tao Yu, Xiazhen Xiao, Zhi Huang, Bingfeng Liang, Tingbo Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma |
title | Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma |
title_full | Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma |
title_fullStr | Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma |
title_full_unstemmed | Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma |
title_short | Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma |
title_sort | salvage liver transplant versus primary liver transplant for patients with hepatocellular carcinoma |
topic | Meta-Analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248033/ https://www.ncbi.nlm.nih.gov/pubmed/30072683 http://dx.doi.org/10.12659/AOT.908623 |
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