Living Related Liver Transplantation for Hepatocellular Carcinoma in Egypt

El-Meteini, Mahmoud; Fayez, Alaaeldin; Fathy, Mohamed; Abdalaal, Amr; Safaan, H; Mostafa, Ibrahim; Abdalaal, Mohamed; Mokhtar, Abeer A; Salah, M.; Eldorry, Ahmed; Abdalwahab, S.; El-Monayeri, Magda; Boillot, Olivier

doi:10.1016/j.transproceed.2005.08.037

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…However, due to the shortage of suitable liver donors not all patients with HCC and cirrhosis are candidates for liver transplantation [97]. Living donor transplantation is the most feasible alternative and increasingly is associated with reports of good outcomes for appropriately selected patients [103,104]. Of importance, however, extrahepatic spread of HCC is associated with a worse prognosis after hepatic transplantation because of the immunossuppression associated with the transplantation and apparently accelerated tumor spread.…”

Section: Treatmentmentioning

confidence: 99%

Molecular Pathogenesis of Hepatocellular Carcinoma

McKillop

Moran

Jin

et al. 2006

Journal of Surgical Research

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Section: Treatmentmentioning

confidence: 99%

Molecular Pathogenesis of Hepatocellular Carcinoma

McKillop

Moran

Jin

et al. 2006

Journal of Surgical Research

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“…Markov models of life‐years gained51 and cost‐effectiveness52 both support the use of LDLT for HCC candidates, even when donor mortality risk is accounted for in the models. At the present time, recipients of deceased or living donor grafts apparently have similar outcomes,48 although there are concerns that immediate application of liver transplantation made possible by LDLT may allow for selection of cases with rapidly progressive tumor biology that would be otherwise selected out by the waiting process inherent in deceased donor transplantation. This concern was raised in a few recent reports in which patients with HCC who received LDLT had increased early recurrence rates compared with HCC recipients of deceased donor grafts 53, 54.…”

Section: Priority Listing Of Patients With Hccmentioning

confidence: 99%

“…Another method for providing timely transplantation for patients with HCC is through living donor liver transplantation (LDLT). This strategy has been applied around the world in areas where there are few deceased donors47–50 and in cases where a candidate may not have to wait for extended periods of time and face the risk of tumor progression beyond a favorable stage. Markov models of life‐years gained51 and cost‐effectiveness52 both support the use of LDLT for HCC candidates, even when donor mortality risk is accounted for in the models.…”

Section: Priority Listing Of Patients With Hccmentioning

confidence: 99%

“…This concern was raised in a few recent reports in which patients with HCC who received LDLT had increased early recurrence rates compared with HCC recipients of deceased donor grafts 53, 54. However, other investigators have found equal posttransplantation disease‐free survival55 and intent‐to‐treat results48 for LDLT compared with deceased donor liver transplantation for HCC.…”

Section: Priority Listing Of Patients With Hccmentioning

confidence: 99%

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Transplantation for hepatocellular carcinoma: The Milan criteria and beyond

Freeman

2006

Liver Transpl

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Key Concepts: 1. Liver transplantation offers excellent results for selected candidates with hepatocellular carcinoma (HCC). 2. Selection strategies have evolved but are mainly based on size and number of tumors, which are surrogates for vascular invasion. Newer techniques show promise for identifying patients at high risk for recurrence and selecting those with low risk, even though they may exceed currently established tumor size criteria. 3. Evaluation of the effectiveness of liver transplantation for HCC requires an intent-to-treat approach that must include an accounting of the dropout rate of patients while waiting. 4. Locoregional pretransplantation adjuvant treatments may have some role for downstaging and/or reducing the dropout rate before transplantation, but their posttransplantation effect on outcome remains undetermined. 5. Liver allocation for HCC candidates in the context of increasing HCC prevalence requires better and evidence-based prioritization policies. Liver Transpl 12:The first human liver transplants were performed for patients with extremely large hepatic tumors. 1 Results from these early cases were poor, and there was a general lack of enthusiasm for the use of this extremely constrained donor resource for patients in whom cancer recurrence was high. 2 However, reports in the late 1980s and early 1990s indicated that good results could be achieved when candidates with less advanced tumors were selected for transplantation. 3,4 Subsequently, Mazzaferro et al. 5 reported excellent 3-year survival rates for patients with a single hepatocellular cancer (HCC) lesion Ͻ5 cm in size or 3 or fewer lesions with the largest being Ͻ3 cm in size. These so-called Milan criteria have been accepted worldwide as identifying candidates with good prognoses and low recurrence rates (Table 1). Many more recent reports have documented excellent overall and recurrence-free survival rates for patients with cirrhosis and HCC treated with liver transplantation with results equal to, 6,7 or better than, 8,9 the results for liver transplantation for nonmalignant indications. Thus, early-stage HCC has become an accepted and standard indication for liver transplantation. Indeed, adherence to these criteria has resulted in improved posttransplantation patient survival in the more recent liver transplant experience. 9 SELECTION CRITERIA AND TUMOR BIOLOGYWith the increased acceptance of HCC as a legitimate indication for liver transplantation and the recognition that liver transplantation offers the possibility of cure to many more patients than resection alone, 10 investigators have begun to examine tumor characteristics beyond the Milan criteria that may identify candidates with low risk of recurrence. Yao et al. 11 found that liver transplant candidates with single tumors Յ6.5 cm in diameter, or Յ3 tumors with the largest being Յ4.5 cm in diameter and a total tumor burden of Յ8 cm (socalled UCSF criteria), achieved excellent results after liver transplantation that were no different than for patients whose tumors...

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“…Since 2001, adult-to-adult living donor liver transplantation (ALDLT) has been the only available treatment with curative intent for patients with end-stage liver disease (ESLD) in Egypt. 1,2 There is an absence of a deceased donor transplant programme as a result of the ongoing debate around brain stem death and the issuing of a comprehensive transparent organ transplant law. The concerns that patients have only one chance with an equivalent graft and patient survivals together with the challenges of donor risk adds to the complexity of the situation.…”

Section: Introductionmentioning

confidence: 99%