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Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes

BACKGROUND: In the context of liver transplantation for hepatocellular carcinoma (HCC), traditional transplant criteria appear restrictive. The objective of the current study was to determine risk factors for recurrence and improve transplant eligibility in patients with HCC. MATERIALS AND METHODS:...

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Autores principales: Hafeez Bhatti, Abu Bakar, Qureshi, Ammal Imran, Tahir, Rizmi, Almas, Talal, Rana, Atif
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281598/
https://www.ncbi.nlm.nih.gov/pubmed/34295467
http://dx.doi.org/10.1016/j.amsu.2021.102552
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author Hafeez Bhatti, Abu Bakar
Qureshi, Ammal Imran
Tahir, Rizmi
Almas, Talal
Rana, Atif
author_facet Hafeez Bhatti, Abu Bakar
Qureshi, Ammal Imran
Tahir, Rizmi
Almas, Talal
Rana, Atif
author_sort Hafeez Bhatti, Abu Bakar
collection PubMed
description BACKGROUND: In the context of liver transplantation for hepatocellular carcinoma (HCC), traditional transplant criteria appear restrictive. The objective of the current study was to determine risk factors for recurrence and improve transplant eligibility in patients with HCC. MATERIALS AND METHODS: This was a retrospective study of patients who underwent living donor liver transplant (LDLT) for HCC (n = 219). Largest tumor diameter, tumor number, AFP and neutrophil to lymphocyte ratio were assessed. Multivariate analysis was performed to develop risk scores. The new model was compared with seven previously published transplant criteria using receiver operator curves. RESULTS: Largest tumor size >3.7 cm [HR:2.6, P = 0.02], and AFP > 600 ng/ml [HR:4.7, P = 0.001] were independent predictors of recurrence. Patients with risk scores of 0, 1–3, 4–6 and 7–9 had recurrence rate of 5.9%, 12.5%, 25% and 58.4% respectively. When compared with Milan criteria, Metro ticket 2.0, AFP model and Samsung criteria; transplant eligibility increased by 31.5%, 22.9%, 8.7%, and 7% respectively. Recurrence rate with the current model was 16/199 (8%) (P < 0.0001) and was comparable with other transplant criteria (6.9–9.1%). On ROC analysis, only Milan criteria (AUC = 0.7, P = 0.001) and the current model (AUC = 0.66, P = 0.01) showed significance for recurrence. All patients with high risk scores within Milan criteria had recurred at 3 years (P = 0.03). CONCLUSIONS: Low AFP can be used to select patients for LDLT outside traditional criteria for HCC, with comparable recurrence rates.
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spelling pubmed-82815982021-07-21 Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes Hafeez Bhatti, Abu Bakar Qureshi, Ammal Imran Tahir, Rizmi Almas, Talal Rana, Atif Ann Med Surg (Lond) Cohort Study BACKGROUND: In the context of liver transplantation for hepatocellular carcinoma (HCC), traditional transplant criteria appear restrictive. The objective of the current study was to determine risk factors for recurrence and improve transplant eligibility in patients with HCC. MATERIALS AND METHODS: This was a retrospective study of patients who underwent living donor liver transplant (LDLT) for HCC (n = 219). Largest tumor diameter, tumor number, AFP and neutrophil to lymphocyte ratio were assessed. Multivariate analysis was performed to develop risk scores. The new model was compared with seven previously published transplant criteria using receiver operator curves. RESULTS: Largest tumor size >3.7 cm [HR:2.6, P = 0.02], and AFP > 600 ng/ml [HR:4.7, P = 0.001] were independent predictors of recurrence. Patients with risk scores of 0, 1–3, 4–6 and 7–9 had recurrence rate of 5.9%, 12.5%, 25% and 58.4% respectively. When compared with Milan criteria, Metro ticket 2.0, AFP model and Samsung criteria; transplant eligibility increased by 31.5%, 22.9%, 8.7%, and 7% respectively. Recurrence rate with the current model was 16/199 (8%) (P < 0.0001) and was comparable with other transplant criteria (6.9–9.1%). On ROC analysis, only Milan criteria (AUC = 0.7, P = 0.001) and the current model (AUC = 0.66, P = 0.01) showed significance for recurrence. All patients with high risk scores within Milan criteria had recurred at 3 years (P = 0.03). CONCLUSIONS: Low AFP can be used to select patients for LDLT outside traditional criteria for HCC, with comparable recurrence rates. Elsevier 2021-07-10 /pmc/articles/PMC8281598/ /pubmed/34295467 http://dx.doi.org/10.1016/j.amsu.2021.102552 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Cohort Study
Hafeez Bhatti, Abu Bakar
Qureshi, Ammal Imran
Tahir, Rizmi
Almas, Talal
Rana, Atif
Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes
title Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes
title_full Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes
title_fullStr Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes
title_full_unstemmed Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes
title_short Liver transplantation for hepatocellular carcinoma: Improving eligibility without compromising outcomes
title_sort liver transplantation for hepatocellular carcinoma: improving eligibility without compromising outcomes
topic Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281598/
https://www.ncbi.nlm.nih.gov/pubmed/34295467
http://dx.doi.org/10.1016/j.amsu.2021.102552
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