Liver Transplant Results for Hepatocellular Carcinoma Applying Strict Preoperative Selection Criteria

Santoyo-Santoyo, Julio; Suárez, Miguel Ángel; Fernández-Aguilar, José Luis; Jimenez, Maria Luisa; Daga, J.A. Pérez; Sánchez-Pérez, Belinda; Poveda, Iván González; González-Sánchez, Antonio Jesús; Ramirez, Carlo B.; Fuente, A. de la

doi:10.1016/j.transproceed.2005.02.059

Cited by 13 publications

(8 citation statements)

References 10 publications

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“…For HCCs fulfi lling the Milan criteria, 57 5-year overall survival rates of 62%-70% have been reported. [60][61][62] However, the high dropout rate from the waiting list because of the severe graft shortage remains a critical problem. 63 The old graft allocation policy in the United States, based on the Child-Turcotte-Pugh score, tended to underestimate the priority of HCC patients, because this score is calculated by liver function-related factors, and not tumor-related factors.…”

Section: Deceased Donor Liver Transplantation For Hccmentioning

confidence: 99%

Surgical treatment of hepatocellular carcinoma

Hasegawa

Kokudo

2009

Surg Today

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Local tumor control is still the most important consideration in the treatment of hepatocellular carcinoma (HCC). Surgical treatments, including liver resection and liver transplantation are, and will remain, the first-line therapeutic strategies for local control in patients with primary HCC. Although aggressive liver resection is often performed for advanced HCC in patients with a large tumor, multiple tumors, or tumors with vascular invasion, liver transplantation is the preferred option, after taking into consideration age and tumor-related factors, when there is poor liver functional reserve. Preventing deterioration in liver function is the second priority in the treatment of HCC. When performing liver resection, extensive removal of noncancerous liver parenchyma during lobectomy or hemihepatectomy, should be avoided as much as possible. Anatomic resection, which refers to systematic elimination of the main tumor with its minute metastases, preserves liver function and is highly recommended. A treatment algorithm based on published evidence is now available, which helps us decide on the most suitable therapeutic option for individual patients, depending on the tumor characteristics and liver functional reserve.

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Section: Deceased Donor Liver Transplantation For Hccmentioning

confidence: 99%

Surgical treatment of hepatocellular carcinoma

Hasegawa

Kokudo

2009

Surg Today

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“…Even though there have been very few reports regarding the accuracy of pre-operative radiologic studies in selecting patients eligible for transplantation according to the Milan or UCSF criteria [21,22] , multiple studies have been published evaluating the sensitivity and positive predictive value of radiologic modalities in detecting HCCs. Table 1 summarizes the diagnostic performances of SDCT, MDCT, dynamic gadolinium (Gd)-enhanced MRI, superparamagnetic iron oxide (SPIO)-enhanced MRI and double-contrast MRI using both gadolinium and SPIO.…”

Section: Difficulties In Analyzing Performances Of Radiologic Modalitmentioning

confidence: 99%

Diagnostic Accuracy of Multi-/Single-Detector Row CT and Contrast-Enhanced MRI in the Detection of Hepatocellular Carcinomas Meeting the Milan Criteria before Liver Transplantation

Kim¹,

Choi²,

Lee³

et al. 2008

Intervirology

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Liver transplantation has been considered to be the only causal treatment for liver cirrhosis patients with hepatocellular carcinoma (HCC) due to its theoretical advantage of eliminating both the tumor and liver disease. However, because of the shortage of donor organs, it is strongly recommended that liver transplantations should be performed on cirrhotic patients with HCCs only when the patients meet the predetermined criteria in terms of number and extent of HCCs. Imaging is thus decisive in the patient inclusion or exclusion from transplantation lists. The imaging techniques used are CT, MRI and ultrasonography. The latter has been proven to be ineffective for HCC surveillance in transplant recipients because of its heavy operator dependence and unreliable detection of small and intermediately sized HCCs. The purpose of this article, then, is to systematically review the diagnostic performances of single-/multidetector row CT, dynamic gadolinium-enhanced MRI, superparamagnetic iron oxide (SPIO)-enhanced MRI and double-contrast MRI using both gadolinium and SPIO for the detection of HCCs with special emphasis on liver transplantation.

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“…This may be more inline with the published results of a larger cohort where radiological screening did account for a significant variation in tumour size between pre-and post-OLT hepatic morphology [17]. Some of the previous studies analysed survival outcomes by expanding patient selection criteria and have reported conflicting results [15,16]. Results from a large cohort of 467 HCC patients compared pre-and post-OLT tumour morphology and found inferior outcomes for UCSF criteria on pre-OLT evaluation as compared with Milan criteria; however, on explanted liver morphology both criteria had similar survival outcomes [17].…”

Section: Discussionmentioning

confidence: 53%

“…Newer diagnostic modalities including the use of helicoidal CT scan and double-contrast MRI has high specificity and sensitivity of greater than 90% in the preoperative detection and staging of HCC [15]. Although concerns regarding the inaccuracy of imaging modalities for diagnosing HCC have been raised from the results of the largest HCC transplant cohort [16]. This study has highlighted the potential bias in allocation process for the scarcely available organs.…”

Section: Discussionmentioning

confidence: 93%