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Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases
IMPORTANCE: Colorectal cancer is a leading cause of cancer-related death, and nearly 70% of patients with this cancer have unresectable colorectal cancer liver metastases (CRLMs). Compared with chemotherapy, liver transplant has been reported to improve survival in patients with CRLMs, but in North...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968681/ https://www.ncbi.nlm.nih.gov/pubmed/35353121 http://dx.doi.org/10.1001/jamasurg.2022.0300 |
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author | Hernandez-Alejandro, Roberto Ruffolo, Luis I. Sasaki, Kazunari Tomiyama, Koji Orloff, Mark S. Pineda-Solis, Karen Nair, Amit Errigo, Jennie Dokus, M. Katherine Cattral, Mark McGilvray, Ian D. Ghanekar, Anand Gallinger, Steven Selzner, Nazia Claasen, Marco P. A. W. Burkes, Ron Hashimoto, Koji Fujiki, Masato Quintini, Cristiano Estfan, Bassam N. Kwon, Choon Hyuck David Menon, K. V. Narayanan Aucejo, Federico Sapisochin, Gonzalo |
author_facet | Hernandez-Alejandro, Roberto Ruffolo, Luis I. Sasaki, Kazunari Tomiyama, Koji Orloff, Mark S. Pineda-Solis, Karen Nair, Amit Errigo, Jennie Dokus, M. Katherine Cattral, Mark McGilvray, Ian D. Ghanekar, Anand Gallinger, Steven Selzner, Nazia Claasen, Marco P. A. W. Burkes, Ron Hashimoto, Koji Fujiki, Masato Quintini, Cristiano Estfan, Bassam N. Kwon, Choon Hyuck David Menon, K. V. Narayanan Aucejo, Federico Sapisochin, Gonzalo |
author_sort | Hernandez-Alejandro, Roberto |
collection | PubMed |
description | IMPORTANCE: Colorectal cancer is a leading cause of cancer-related death, and nearly 70% of patients with this cancer have unresectable colorectal cancer liver metastases (CRLMs). Compared with chemotherapy, liver transplant has been reported to improve survival in patients with CRLMs, but in North America, liver allograft shortages make the use of deceased-donor allografts for this indication problematic. OBJECTIVE: To examine survival outcomes of living-donor liver transplant (LDLT) for unresectable, liver-confined CRLMs. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included patients at 3 North American liver transplant centers with established LDLT programs, 2 in the US and 1 in Canada. Patients with liver-confined, unresectable CRLMs who had demonstrated sustained disease control on oncologic therapy met the inclusion criteria for LDLT. Patients included in this study underwent an LDLT between July 2017 and October 2020 and were followed up until May 1, 2021. EXPOSURES: Living-donor liver transplant. MAIN OUTCOMES AND MEASURES: Perioperative morbidity and mortality of treated patients and donors, assessed by univariate statistics, and 1.5-year Kaplan-Meier estimates of recurrence-free and overall survival for transplant recipients. RESULTS: Of 91 evaluated patients, 10 (11%) underwent LDLT (6 [60%] male; median age, 45 years [range, 35-58 years]). Among the 10 living donors, 7 (70%) were male, and the median age was 40.5 years (range, 27-50 years). Kaplan-Meier estimates for recurrence-free and overall survival at 1.5 years after LDLT were 62% and 100%, respectively. Perioperative morbidity for both donors and recipients was consistent with established standards (Clavien-Dindo complications among recipients: 3 [10%] had none, 3 [30%] had grade II, and 4 [40%] had grade III; donors: 5 [50%] had none, 4 [40%] had grade I, and 1 had grade III). CONCLUSIONS AND RELEVANCE: This study’s findings of recurrence-free and overall survival rates suggest that select patients with unresectable, liver-confined CRLMs may benefit from total hepatectomy and LDLT. |
format | Online Article Text |
id | pubmed-8968681 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-89686812022-04-20 Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases Hernandez-Alejandro, Roberto Ruffolo, Luis I. Sasaki, Kazunari Tomiyama, Koji Orloff, Mark S. Pineda-Solis, Karen Nair, Amit Errigo, Jennie Dokus, M. Katherine Cattral, Mark McGilvray, Ian D. Ghanekar, Anand Gallinger, Steven Selzner, Nazia Claasen, Marco P. A. W. Burkes, Ron Hashimoto, Koji Fujiki, Masato Quintini, Cristiano Estfan, Bassam N. Kwon, Choon Hyuck David Menon, K. V. Narayanan Aucejo, Federico Sapisochin, Gonzalo JAMA Surg Original Investigation IMPORTANCE: Colorectal cancer is a leading cause of cancer-related death, and nearly 70% of patients with this cancer have unresectable colorectal cancer liver metastases (CRLMs). Compared with chemotherapy, liver transplant has been reported to improve survival in patients with CRLMs, but in North America, liver allograft shortages make the use of deceased-donor allografts for this indication problematic. OBJECTIVE: To examine survival outcomes of living-donor liver transplant (LDLT) for unresectable, liver-confined CRLMs. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included patients at 3 North American liver transplant centers with established LDLT programs, 2 in the US and 1 in Canada. Patients with liver-confined, unresectable CRLMs who had demonstrated sustained disease control on oncologic therapy met the inclusion criteria for LDLT. Patients included in this study underwent an LDLT between July 2017 and October 2020 and were followed up until May 1, 2021. EXPOSURES: Living-donor liver transplant. MAIN OUTCOMES AND MEASURES: Perioperative morbidity and mortality of treated patients and donors, assessed by univariate statistics, and 1.5-year Kaplan-Meier estimates of recurrence-free and overall survival for transplant recipients. RESULTS: Of 91 evaluated patients, 10 (11%) underwent LDLT (6 [60%] male; median age, 45 years [range, 35-58 years]). Among the 10 living donors, 7 (70%) were male, and the median age was 40.5 years (range, 27-50 years). Kaplan-Meier estimates for recurrence-free and overall survival at 1.5 years after LDLT were 62% and 100%, respectively. Perioperative morbidity for both donors and recipients was consistent with established standards (Clavien-Dindo complications among recipients: 3 [10%] had none, 3 [30%] had grade II, and 4 [40%] had grade III; donors: 5 [50%] had none, 4 [40%] had grade I, and 1 had grade III). CONCLUSIONS AND RELEVANCE: This study’s findings of recurrence-free and overall survival rates suggest that select patients with unresectable, liver-confined CRLMs may benefit from total hepatectomy and LDLT. American Medical Association 2022-03-30 2022-06 /pmc/articles/PMC8968681/ /pubmed/35353121 http://dx.doi.org/10.1001/jamasurg.2022.0300 Text en Copyright 2022 Hernandez-Alejandro R et al. JAMA Surgery. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Hernandez-Alejandro, Roberto Ruffolo, Luis I. Sasaki, Kazunari Tomiyama, Koji Orloff, Mark S. Pineda-Solis, Karen Nair, Amit Errigo, Jennie Dokus, M. Katherine Cattral, Mark McGilvray, Ian D. Ghanekar, Anand Gallinger, Steven Selzner, Nazia Claasen, Marco P. A. W. Burkes, Ron Hashimoto, Koji Fujiki, Masato Quintini, Cristiano Estfan, Bassam N. Kwon, Choon Hyuck David Menon, K. V. Narayanan Aucejo, Federico Sapisochin, Gonzalo Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases |
title | Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases |
title_full | Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases |
title_fullStr | Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases |
title_full_unstemmed | Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases |
title_short | Recipient and Donor Outcomes After Living-Donor Liver Transplant for Unresectable Colorectal Liver Metastases |
title_sort | recipient and donor outcomes after living-donor liver transplant for unresectable colorectal liver metastases |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968681/ https://www.ncbi.nlm.nih.gov/pubmed/35353121 http://dx.doi.org/10.1001/jamasurg.2022.0300 |
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