Living Donor Liver Transplantation for Hepatocellular Carcinoma: A Single-Center Experience from Pakistan

Bhatti, Abu Bakar Hafeez; Dar, Faisal Saud; Qureshi, Ammal Imran; Khan, Nusrat Yar; Zia, Haseeb; Haider, Siraj; Shah, Najmul Hassan; Rana, Atif

doi:10.1016/j.jceh.2019.04.052

Cited by 11 publications

(13 citation statements)

References 26 publications

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“…Details of diagnostic workup and patient selection for transplantation have been reported elsewhere [ 10 , 11 ]. The diagnosis of HCC was made on a liver dynamic CT scan.…”

Section: Methodsmentioning

confidence: 99%

When to call it off: defining transplant candidacy limits in liver donor liver transplantation for hepatocellular carcinoma

et al. 2020

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Background Living donor liver transplantation (LDLT) is an acceptable treatment option for hepatocellular carcinoma (HCC). Traditional transplant criteria aim at best utilization of donor organs with low risk of post transplant recurrence. In LDLT, long term recurrence free survival (RFS) of 50% is considered acceptable. The objective of the current study was to determine preoperative factors associated with high recurrence rates in LDLT. Methods Between April 2012 and December 2019, 898 LDLTs were performed at our center. Out of these, 242 were confirmed to have HCC on explant histopathology. We looked at preoperative factors associated with ≤ 50%RFS at 4 years. For survival analysis, Kaplan Meier curves were used and Cox regression analysis was used to identify independent predictors of recurrence. Results Median AFP was 14.4(0.7–11,326.7) ng/ml. Median tumor size was 2.8(range = 0.1–11) cm and tumor number was 2(range = 1–15). On multivariate analysis, AFP > 600 ng/ml [HR:6, CI: 1.9–18.4, P = 0.002] and microvascular invasion (MVI) [HR:5.8, CI: 2.5–13.4, P < 0.001] were independent predictors of 4 year RFS ≤ 50%. When AFP was > 600 ng/ml, MVI was seen in 88.9% tumors with poor grade and 75% of tumors outside University of California San Francisco criteria. Estimated 4 year RFS was 78% for the entire cohort. When AFP was < 600 ng/ml, 4 year RFS for well-moderate and poor grade tumors was 88 and 73%. With AFP > 600 ng/ml, RFS was 53% and 0 with well-moderate and poor grade tumors respectively ( P < 0.001). Conclusion Patients with AFP < 600 ng/ml have acceptable outcomes after LDLT. In patients with AFP > 600 ng/ml, a preoperative biopsy to rule out poor differentiation should be considered for patient selection.

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“…Details of diagnostic workup and patient selection for transplantation have been reported elsewhere [ 10 , 11 ]. The diagnosis of HCC was made on a liver dynamic CT scan.…”

Section: Methodsmentioning

confidence: 99%

When to call it off: defining transplant candidacy limits in liver donor liver transplantation for hepatocellular carcinoma

et al. 2020

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“…However, there is lack of well-established criteria for DS, not all patients with advanced HCC (T3–T4) are suitable candidates, and some might decompensate further with potential risk of death with DS ( 6 , 7 ). There is growing evidence that bio markers like AFP might play an important role in predicting post-transplant recurrence in patients with tumors outside traditional transplant criteria ( 8 – 10 ). Thus, DS might not be needed in all patients with T3–T4 HCC to determine transplant candidacy.…”

Section: Introductionmentioning

confidence: 99%

Living Donor Liver Transplantation for Hepatocellular Carcinoma: Appraisal of the United Network for Organ Sharing Modified TNM Staging

2021

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Background: In deceased donor liver transplantation (DDLT), transplant eligibility for T3–T4 HCC requires successful downstaging (DS). Living donor liver transplantation (LDLT) can be considered selectively in these patients without DS, but its role is not defined. The objective of the current study was to assess outcomes of LDLT for HCC based on UNOS staging with no prior DS.Materials and Methods: Patients who underwent LDLT for HCC (n = 262) were staged based on modified UNOS TNM staging. High-risk factors were identified and 5-year recurrence free survival was compared in patients with T2–T4 HCC.Results: Median follow-up was 30.2 (16.4–46.3) months. Recurrence rate in T1, T2, T3, T4a, and T4b HCC was 0, 10.1, 16.1, 5.9, and 37.5% (P = 0.02), respectively. On multivariate analysis, AFP > 600 ng/mL [HR:11.7, P < 0.001] and T4b HCC (macrovascular invasion) [HR = 5.6, P = 0.03] were predictors of recurrence. After exclusion of AFP > 600 ng/mL, 5-year RFS for T2, T3, and T4a HCC was 94, 86, and 92% (P = 0.3). Rate of microvascular invasion between T2 and T3 HCC was 24.3 vs. 53.6% (P = 0.005), and between T2 and T4a HCC was 24.3 vs. 36.7% (P = 0.2). Overall, 26 (19.4%) patients were overstaged and 23 (17.1%) were understaged on preoperative imaging. The 5-year RFS in patients with identical preoperative and histopathological staging was 94, 87, and 94% (P = 0.6).Conclusion: LDLT without prior DS leads to comparable survival for UNOS T2, T3, and T4a HCC as long as AFP is < 600 ng/mL.

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“…Extrahepatic metastasis and main portal vein tumor invasion were considered absolute contraindications to transplantation. Down staging protocol for larger tumors and use of pre transplant treatments as a bridge to transplantation have been previously detailed [ 4 ]. After transplantation, patients diagnosed with i-CC or h-CC were kept under surveillance with 3–6 monthly CT scan and AFP and CA-19-9 for 6 months, then for 2 years and annually thereafter.…”

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confidence: 99%

Living donor liver transplantation for intra hepatic cholangiocarcinoma

Bhatti

Tahir

Qureshi

et al. 2020

Annals of Medicine and Surgery

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Living Donor Liver Transplantation for Hepatocellular Carcinoma: A Single-Center Experience from Pakistan

Cited by 11 publications

References 26 publications

When to call it off: defining transplant candidacy limits in liver donor liver transplantation for hepatocellular carcinoma

When to call it off: defining transplant candidacy limits in liver donor liver transplantation for hepatocellular carcinoma

Living Donor Liver Transplantation for Hepatocellular Carcinoma: Appraisal of the United Network for Organ Sharing Modified TNM Staging

Living donor liver transplantation for intra hepatic cholangiocarcinoma

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