Liver Transplantation for Hepatocellular Carcinoma

Befeler, Alex S.; Hayashi, Paul H.; Bisceglie, Adrian M. Di

doi:10.1053/j.gastro.2005.03.033

Cited by 120 publications

(88 citation statements)

References 87 publications

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“…Since the prognosis for HCC patients enrolled for LT depends not only on the criteria adopted for listing and delist- ing, but also on adjuvant treatment strategies and time on the waiting list (1,20), we discussed these 3 issues separately.…”

Section: Discussionmentioning

confidence: 99%

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Intention-to-Treat Analysis of Liver Transplantation in Selected, Aggressively Treated HCC Patients Exceeding the Milan Criteria

Cillo

Vitale

Grigoletto

et al. 2007

American Journal of Transplantation

106

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This prospective study analyzed the dropout probability and intention-to-treat survival rates of patients with hepatocellular carcinoma (HCC) selected and treated according to our policy before liver transplantation (LT), with particular attention to those exceeding the Milan criteria. Exclusion criteria for LT were macroscopic vascular invasion, metastases, and poorly differentiated disease at percutaneous biopsy. A specific multi-modal adjuvant algorithm was used to treat HCC before LT. A total of 100 HCC patients were listed for LT: 40 exceeded the Milan criteria in terms of nodule size and number (MILAN OUT) either at listing or in list, while 60 patients continued to meet the criteria (MI-LAN IN). The Milan criteria did not prove to be a significant predictor of dropout probability or survival rates using Cox's analysis. Cumulative dropout probability at 6 and 12 months was 0% and 4% for MILAN OUT, and 6% and 11% for MILAN IN. The intention-to-treat survival rates at 1 and 3 years were 95% and 85% in MI-LAN OUT, and 84% and 69% in MILAN IN. None of the 68 transplanted patients had recurrent HCC after a median 16-month follow-up (0-69 months). In conclusion, LT may be effective for selected, aggressively-treated HCC patients exceeding the Milan criteria.

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Section: Discussionmentioning

confidence: 99%

“…Liver transplantation (LT) is an appealing treatment for hepatocellular carcinoma (HCC) because it achieves the widest possible resection margins for the cancer, removing the remaining liver tissue, which risks developing de novo tumors and restoring liver function (1).…”

Section: Introductionmentioning

confidence: 99%

Intention-to-Treat Analysis of Liver Transplantation in Selected, Aggressively Treated HCC Patients Exceeding the Milan Criteria

Cillo

Vitale

Grigoletto

et al. 2007

American Journal of Transplantation

106

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“…In the current study, cases of HCC identified within 12 months of enrollment were excluded as the tumors may have been present prior to entry into the trial. Although 23% (11/48) of the HCC cases in our trial were categorized as presumed, rather than definite, HCC, almost all of these cases fulfilled currently accepted diagnostic criteria for HCC [34][35][36] . Indeed, the diagnostic criteria utilized in this study were very stringent, and the outcome was the same whether we included presumed cases or not.…”

Section: Discussionmentioning

confidence: 82%

Incidence of Hepatocellular Carcinoma and Associated Risk Factors in Hepatitis C-Related Advanced Liver Disease

Harnois¹

2009

Yearbook of Gastroenterology

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“…The first outcomes with LT for HCC showed low survival rates and high recurrence rates after transplantation [10,11]. The early outcomes with LT for HCC with an extensive tumor burden had discouraging outcomes due to HCC recurrence [12]. At that time, the recurrence rates at 3 years after LT were 43 and 54 %, respectively [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria

et al. 2014

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Liver transplantation (LT) is the most effective treatment for hepatocellular carcinoma (HCC) that arises from cirrhosis. The Milan and the University of California, San Francisco (UCSF) selection criteria have resulted in major improvements in patient survival. We assessed our outcomes for patients with HCC that were beyond the Milan and UCSF criteria after living donor liver transplantation. We reviewed the data for 109 patients with cirrhosis and HCC who underwent living donor right lobe liver transplantation (living donor liver transplantation; LDLT) during the period from July 2004 to July 2012. Sixteen (14.7 %) patients had HCC recurrences during a mean follow-up of 35.4±26.2 months (range 4-100 months). The mean time to recurrence was 11±9.4 months (range 4-26 months). Survival rates were not significantly different between patients with HCC that met and were beyond the Milan and UCSF criteria (p=0.761 and p=0.861, respectively). The Milan and UCSF criteria were not independent risk factors for HCC recurrence or patient survival. Only poorly differentiated tumors were associated with a lower survival rate (OR=8.656, 95 % confidence interval (CI) 2.01-37.16; p= 0.004). Survival rates for patients with HCC that were beyond conventional selection criteria should encourage reconsidering the acceptable thresholds of these criteria so that more HCC patients may undergo LT without affecting outcomes.

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Liver Transplantation for Hepatocellular Carcinoma

Cited by 120 publications

References 87 publications

Intention-to-Treat Analysis of Liver Transplantation in Selected, Aggressively Treated HCC Patients Exceeding the Milan Criteria

Intention-to-Treat Analysis of Liver Transplantation in Selected, Aggressively Treated HCC Patients Exceeding the Milan Criteria

Incidence of Hepatocellular Carcinoma and Associated Risk Factors in Hepatitis C-Related Advanced Liver Disease

Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria

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