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Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation

Milan criteria are widely used for liver transplantation selection in hepatocellular carcinoma but have been recognized to be too restrictive. Milan-out criteria are increasingly being adopted. Our aim was to analyze if liver transplantation waitlisted Milan-out hepatocellular carcinoma patients hav...

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Autores principales: Herreras, Julia, Di Maira, Tommaso, Vinaixa, Carmen, San Juan, Fernando, Rubín, Ángel, Berenguer, Marina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791598/
https://www.ncbi.nlm.nih.gov/pubmed/31723582
http://dx.doi.org/10.1097/TXD.0000000000000934
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author Herreras, Julia
Di Maira, Tommaso
Vinaixa, Carmen
San Juan, Fernando
Rubín, Ángel
Berenguer, Marina
author_facet Herreras, Julia
Di Maira, Tommaso
Vinaixa, Carmen
San Juan, Fernando
Rubín, Ángel
Berenguer, Marina
author_sort Herreras, Julia
collection PubMed
description Milan criteria are widely used for liver transplantation selection in hepatocellular carcinoma but have been recognized to be too restrictive. Milan-out criteria are increasingly being adopted. Our aim was to analyze if liver transplantation waitlisted Milan-out hepatocellular carcinoma patients have different outcome than Milan patients. METHODS. Retrospective study including all consecutive patients with hepatocellular carcinoma admitted in the waiting list for liver transplantation between January 2012 and January 2015. We included 177 patients, 146 of which eventually transplanted. Downstaging was achieved in the Milan-out cases (n = 29) before waitlisting. RESULTS. From diagnosis to last follow-up, 29% patients died. Survival at 1 and 5 years from diagnosis was 93% and 75%, respectively in the within Milan group compared with 91% and 61% in the Milan-out group (P = 0.03). Treatment failure occurred in 20% of cases due to tumor progression in the waiting list (44%), death on the waiting list (20%), and hepatocellular carcinoma recurrence postliver transplantation (9%). Milan-out criteria was the only variable predictive of treatment failure remaining in the multivariate analysis with a hazard ratio (HR) of 1.7 (HR, 1.7; 95% confidence interval, 1.34-4.55; P = 0.010) and HR of 1.43 (1.23-6.5) in the hepatocellular carcinoma recurrence. CONCLUSIONS. Milan-out criteria are associated with a higher intention-to-treat liver transplantation failure from time of inclusion in the waiting list. However, survival rates are still >50% at 5 years of follow-up.
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spelling pubmed-67915982019-11-13 Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation Herreras, Julia Di Maira, Tommaso Vinaixa, Carmen San Juan, Fernando Rubín, Ángel Berenguer, Marina Transplant Direct Liver Transplantation Milan criteria are widely used for liver transplantation selection in hepatocellular carcinoma but have been recognized to be too restrictive. Milan-out criteria are increasingly being adopted. Our aim was to analyze if liver transplantation waitlisted Milan-out hepatocellular carcinoma patients have different outcome than Milan patients. METHODS. Retrospective study including all consecutive patients with hepatocellular carcinoma admitted in the waiting list for liver transplantation between January 2012 and January 2015. We included 177 patients, 146 of which eventually transplanted. Downstaging was achieved in the Milan-out cases (n = 29) before waitlisting. RESULTS. From diagnosis to last follow-up, 29% patients died. Survival at 1 and 5 years from diagnosis was 93% and 75%, respectively in the within Milan group compared with 91% and 61% in the Milan-out group (P = 0.03). Treatment failure occurred in 20% of cases due to tumor progression in the waiting list (44%), death on the waiting list (20%), and hepatocellular carcinoma recurrence postliver transplantation (9%). Milan-out criteria was the only variable predictive of treatment failure remaining in the multivariate analysis with a hazard ratio (HR) of 1.7 (HR, 1.7; 95% confidence interval, 1.34-4.55; P = 0.010) and HR of 1.43 (1.23-6.5) in the hepatocellular carcinoma recurrence. CONCLUSIONS. Milan-out criteria are associated with a higher intention-to-treat liver transplantation failure from time of inclusion in the waiting list. However, survival rates are still >50% at 5 years of follow-up. Wolters Kluwer Health 2019-09-19 /pmc/articles/PMC6791598/ /pubmed/31723582 http://dx.doi.org/10.1097/TXD.0000000000000934 Text en Copyright © 2019 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Liver Transplantation
Herreras, Julia
Di Maira, Tommaso
Vinaixa, Carmen
San Juan, Fernando
Rubín, Ángel
Berenguer, Marina
Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation
title Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation
title_full Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation
title_fullStr Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation
title_full_unstemmed Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation
title_short Milan-out Criteria and Worse Intention-to-Treat Outcome Postliver Transplantation
title_sort milan-out criteria and worse intention-to-treat outcome postliver transplantation
topic Liver Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791598/
https://www.ncbi.nlm.nih.gov/pubmed/31723582
http://dx.doi.org/10.1097/TXD.0000000000000934
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