Liver Transplantation for Advanced Hepatocellular Carcinoma after Downstaging Without Up-Front Stage Restrictions

Chapman, William C.; Garcia‐Aroz, Sandra; Vachharajani, Neeta; Fowler, Kathryn J.; Saad, Nael; Lin, Yiing; Wellen, Jason R.; Tan, Benjamin; Khan, Adeel; Doyle, Maria B. Majella

doi:10.1016/j.jamcollsurg.2016.12.020

Cited by 62 publications

(51 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Based on the present data, one would suggest waiting at least 3 months after downstaging to TTV115/AFP400. In addition, one can intuitively assume that patients with the most advanced original HCCs should wait longer after a successful downstaging . At our institutions, we allow listing after 3 months of stability after downstaging, keeping in mind that patients will still be surveyed during about 1 year on the waiting list.…”

Section: Discussionmentioning

confidence: 99%

Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study

et al. 2018

View full text Add to dashboard Cite

The use of downstaging prior to liver transplantation for hepatocellular carcinoma (HCC) still needs refinement. This study included patients with HCC listed for transplantation according to the Total Tumour Volume (TTV) ≤115 cm and alpha fetoprotein (AFP) ≤400 ng/ml criteria, with and without previous downstaging. Overall, 455 patients were listed, and 286 transplanted. Post-transplant follow-up was 38.5 ± 1.7 months. Patients downstaged to TTV115/AFP400 (n = 29) demonstrated similar disease-free survivals (DFS, 74% vs. 80% at 5 years, P = 0.949), but a trend to more recurrences (14% vs. 5.8%, P = 0.10) than those always within TTV115/AFP400 (n = 257). Similarly, patients downstaged to Milan criteria (n = 80) demonstrated similar DFS (76% vs. 86% at 5 years, P = 0.258), but more recurrences (11% vs. 1.7%, P = 0.001) than those always within Milan (n = 177). Among patients downstaged to Milan, those originally beyond TTV115/AFP400 (n = 27) had similar outcomes as those originally beyond Milan, but within TTV115/AFP400 (n = 53). However, the likelihood of being within Milan at transplant was lower for patients with more advanced original HCCs (P < 0.0001). Overall, despite an expected increase in post-transplant HCC recurrence, similar survivals can be achieved with and without downstaging, using the TTV115/AFP400 transplantation criteria, and including patients with advanced original HCCs. Downstaging should continue to be performed.

show abstract

Section: Discussionmentioning

confidence: 99%

Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…When using expanded criteria, one of the most relevant issues concerns the need to identify parameters capable of predicting which patients will fail to respond to measures to reduce their tumour burden, and therefore benefit from other downstaging treatments. Several studies tried to establish which parameters best predicted successful downstaging, but their value is limited by differences, for instance in: the numbers of patients involved (ranging from 22 to 271); the populations considered (with some reports including patients with macrovascular invasion); the criteria for defining successful downstaging; the cut‐offs used for the same parameter (e.g, AFP levels); the types of downstaging treatment; the radiological criteria used to assess response to treatment; and the duration of the follow‐up to establish a consolidated response to downstaging . Lastly, and most importantly, no randomized controlled trials have examined this issue, and very few of the published studies were prospective.…”

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 99%

“…Several studies tried to establish which parameters best predicted successful downstaging, but their value is limited by differences, for instance in: the numbers of patients involved (ranging from 22 to 271); the populations considered (with some reports including patients with macrovascular invasion); the criteria for defining successful downstaging; the cut-offs used for the same parameter (e.g, AFP levels); the types of downstaging treatment; the radiological criteria used to assess response to treatment; and the duration of the follow-up to establish a consolidated response to downstaging. [153][154][155][156][157][158] Lastly, and most importantly, no randomized controlled trials have examined this issue, and very few of the published studies were prospective. All these shortcomings clearly limit the chances of drawing any firm conclusions regarding this important issue.…”

Section: Commentmentioning

confidence: 99%

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Burra

Giannini

Caraceni

et al. 2018

Liver International

View full text Add to dashboard Cite

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.

show abstract

“…Therefore, downstaging of HCC by liver-directed therapies, such as RFA, TACE, transarterial radioembolization (TARE), stereotactic body radiation (SBRT) or a combination of them, to within the Milan criteria has been proposed as the process of expanding the criteria has not yet reached a definitive conclusion. A recent study compared the survival outcomes between patients presenting initially within the Milan criteria and patients receiving locoregional treatments in order to be downstaged to within the Milan criteria 51 . It was reported that survival rates were similar between the two study arms.…”

Section: Emerging Challenges In Liver Transplantationmentioning

confidence: 99%

The Evolution of Criteria for Liver Transplantation for Hepatocellular Carcinoma: From Milan to San Francisco and All Around the World!

Ziogas¹,

Tsoulfas²

2017

RFMH

View full text Add to dashboard Cite

Introduction: Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third most common cancerrelated cause of death in the world. According to the stage of the disease, each patient is allocated to a different treatment option. Liver transplantation, along with surgical resection, is the only totally therapeutic option and is primarily indicated in HCC patients with underlying cirrhosis. However, the restricted number of liver grafts imposes difficulties in selecting the most suitable patients to receive those limited grafts and therefore certain criteria have been proposed. The Milan criteria are currently the most widely accepted and utilized criteria around the world, despite their restrictiveness. In an attempt to assist HCC patients exceeding them, but with a potential to display acceptable survival outcomes, undergo liver transplantation, research teams worldwide suggest expanded criteria based on their findings. Some of the most broadly known are the University of California, San Francisco (UCSF), Kyoto, Tokyo, Hangzhou and up-to-7 criteria. On the other hand, in order to expand the liver donor pool, grafts may be accepted from living, non-heart beating, elderly, steatotic, or even HCV-infected donors, in addition to the use of split livers with both advantages and disadvantages. The aim of this review is to thoroughly present the current situation of liver transplantation for HCC patients, with a focus on the criteria used and emerging challenges presented. Core tip: Hepatocellular carcinoma (HCC) is the third most common malignancy worldwide and liver transplantation represents the treatment of choice, particularly in the setting of cirrhosis. Lack of grafts led to the utilization of certain criteria in order to determine the eligibility of an HCC patient to access the waiting list. The most widely accepted are the Milan criteria, even though they are thought off as too restrictive. Consequently, transplant research groups all over the world published their own criteria, which showed acceptable outcomes. Living donor liver transplantation and other extended-criteria grafts have been proposed as an alternative to reduced donations. Ziogas IA, Tsoulfas G. The evolution of criteria for liver transplantation for hepatocellular carcinoma: from Milan to San Francisco and all around the world!

show abstract

Liver Transplantation for Advanced Hepatocellular Carcinoma after Downstaging Without Up-Front Stage Restrictions

Cited by 62 publications

References 29 publications

Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study

Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The Evolution of Criteria for Liver Transplantation for Hepatocellular Carcinoma: From Milan to San Francisco and All Around the World!

Contact Info

Product

Resources

About