Can we expand the indications for liver transplantation among hepatocellular carcinoma patients with increased tumor size?

Fernández, JL; Robles, R; Marín, Caridad; Sánchez‐Bueno, Francisco; Ramı́rez, Pablo; Pons, José Antonio; Garre, M; Perez, Daniela; Parrilla, A Clavel; Navalón, Juan Carlos; Parrilla, P.

doi:10.1016/s0041-1345(03)00723-1

Cited by 42 publications

(39 citation statements)

References 19 publications

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“…The University of California, San Francisco (UCSF) criteria were derived from a retrospective study of 70 patients and include patients with a solitary tumour up to 6·5 cm, up to three tumours of 4·5 cm or less, and total tumour diameter up to 8 cm 8 . In this and subsequent studies, this expansion of the Milan criteria did not impact on survival adversely 8,71 . However, by adopting these criteria, more patients with HCC will be offered transplantation and this will reduce the availability of cadaveric grafts for patients with end-stage liver disease.…”

Section: Tumour Staging Systemssupporting

confidence: 49%

“…Recent studies indicate that the Milan criteria may also exclude from transplantation low-risk patients with large, well 74 differentiated tumours. It has been suggested that these criteria may safely be expanded 8,71,72 . The University of California, San Francisco (UCSF) criteria were derived from a retrospective study of 70 patients and include patients with a solitary tumour up to 6·5 cm, up to three tumours of 4·5 cm or less, and total tumour diameter up to 8 cm 8 .…”

Section: Tumour Staging Systemsmentioning

confidence: 99%

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Selection of patients with hepatocellular carcinoma for liver transplantation

Sutcliffe

Maguire

Portmann

et al. 2005

British Journal of Surgery

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In patients with HCC, biological properties of the tumour are more accurate than radiological criteria in determining outcome after transplantation. Despite the risks of tumour biopsy, which may have been previously overstated, histological evaluation before transplantation may have a role and warrants further study. By expanding the donor pool and eliminating waiting times, live donor liver transplantation is a valuable resource that has yet to fulfil its potential because of unresolved ethical issues concerning the safety of the donor. The availability of long-term outcome data may help to clarify this in the near future.

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Section: Tumour Staging Systemssupporting

confidence: 49%

Section: Tumour Staging Systemsmentioning

confidence: 99%

Selection of patients with hepatocellular carcinoma for liver transplantation

Sutcliffe

Maguire

Portmann

et al. 2005

British Journal of Surgery

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“…However, there are other important factors in tumor pathology that could aid patient selection, such as DNA heterogeneity, tumor differentiation degree, and vascular invasion, but pretransplant biopsy is required for detection of these factors and as such risks tumor spread. 11 In the present study, the overall survival (83%) and tumor-free survival (79.5%) were within the expected range. However, we observed a higher rate of HCC recurrence (20.5%), with most (70.5%) within the Milan criteria at transplant time.…”

Section: Discussionsupporting

confidence: 75%

Untitled

2015

Exp Clin Transplant

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Objectives: To identify the predictors of overall survival and tumor-free survival of 88 hepatocellular carcinoma patients who were treated with orthotopic liver transplant at Shiraz Organ Transplant Center. Metarials and Methods: We performed this retrospective study after reviewing the transplant database of all patients who underwent orthotopic liver transplant secondary to hepatocellular carcinoma and liver cirrhosis. Hepatocellular carcinoma was diagnosed in 70 patients before liver transplant and 18 patients on histologic examination of the explanted livers. Cox regression identified independent factors that affected posttransplant survival. Results: The overall survival rate was 83% and the tumor-free survival rate was 79.5%. Independent factors for tumor recurrence were Milan criteria, alpha-fetoprotein level before operation ≥ 400 ng/mL, tumor grade, vascular invasion, and age. Vascular invasion (odds ratio, 5; 95% confidence interval, 1.1 to 25.496; P = .049) and tumor grade (odds ratio, 14.42; 95% confidence interval, 3.652 to 56.95; P < .001 were statistically significant. Conclusions: Vascular invasion and tumor grade were predictive factors for tumor-free survival.

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“…Their study showed that the long-term survival after transplantation for such patients were similar to that of liver transplantation for HCCs within the Milan criteria. Although the expanded criteria have been supported by some other studies [268], there are inadequate data in the literature to validate the long-term survival results using expanded criteria. Furthermore, it has to be noted that Yao's criteria were based on pathologic examination of explants rather than preoperative radiological imaging, which often underestimates the size of the tumor compared with measurement of tumor size in the explants.…”

Section: Liver Transplantationmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Can we expand the indications for liver transplantation among hepatocellular carcinoma patients with increased tumor size?

Cited by 42 publications

References 19 publications

Selection of patients with hepatocellular carcinoma for liver transplantation

Selection of patients with hepatocellular carcinoma for liver transplantation

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Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

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