BACKGROUND: Cadaveric liver transplantation is effective for nonresectable early hepatocellular carcinoma. However, the scarcity of cadaveric organs has prompted some centers to use living donors, which guarantees transplantation, but entails a risk to the donor. In the absence of controlled trials, decision analysis can be used to help explicate the tradeoffs involved when considering living donor versus cadaveric liver transplantation for nonresectable early hepatocellular carcinoma. METHODS: Using a Markov model, a hypothetical cohort of patients with Child's A cirrhosis and a single 3.5-cm tumor received one of three strategies: 1) no transplant; 2) intent to perform cadaveric liver transplantation; or 3) living donor liver transplantation. Data were obtained from natural history and retrospective studies. All probabilities in the model were varied simultaneously using a Monte Carlo simulation. RESULTS: Living-donor liver transplantation was the best strategy, improving life expectancy by 4.5 years compared with cadaveric liver transplantation. This strategy remained dominant even when varying severity of cirrhosis, age, tumor doubling time, tumor growth pattern, blood type, regional transplant volume, initial tumor size, and rate of progression of cirrhosis. CONCLUSIONS: Living-donor liver transplantation should confer a substantial survival advantage for patients with compensated cirrhosis and non-resectable early stage hepatocellular carcinoma.
BACKGROUND: Cadaveric liver transplantation is effective for nonresectable early hepatocellular carcinoma. However, the scarcity of cadaveric organs has prompted some centers to use living donors, which guarantees transplantation, but entails a risk to the donor. In the absence of controlled trials, decision analysis can be used to help explicate the tradeoffs involved when considering living donor versus cadaveric liver transplantation for nonresectable early hepatocellular carcinoma. METHODS: Using a Markov model, a hypothetical cohort of patients with Child's A cirrhosis and a single 3.5-cm tumor received one of three strategies: 1) no transplant; 2) intent to perform cadaveric liver transplantation; or 3) living donor liver transplantation. Data were obtained from natural history and retrospective studies. All probabilities in the model were varied simultaneously using a Monte Carlo simulation. RESULTS: Living-donor liver transplantation was the best strategy, improving life expectancy by 4.5 years compared with cadaveric liver transplantation. This strategy remained dominant even when varying severity of cirrhosis, age, tumor doubling time, tumor growth pattern, blood type, regional transplant volume, initial tumor size, and rate of progression of cirrhosis. CONCLUSIONS: Living-donor liver transplantation should confer a substantial survival advantage for patients with compensated cirrhosis and non-resectable early stage hepatocellular carcinoma.
Authors: W Scott Helton; Adrian Di Bisceglie; Ravi Chari; Myron Schwartz; Jordi Bruix Journal: J Gastrointest Surg Date: 2003 Mar-Apr Impact factor: 3.452
Authors: Carl L Berg; Brenda W Gillespie; Robert M Merion; Robert S Brown; Michael M Abecassis; James F Trotter; Robert A Fisher; Chris E Freise; R Mark Ghobrial; Abraham Shaked; Jeffrey H Fair; James E Everhart Journal: Gastroenterology Date: 2007-09-14 Impact factor: 22.682
Authors: Patrick G Northup; Michael M Abecassis; Michael J Englesbe; Jean C Emond; Vanessa D Lee; George J Stukenborg; Lan Tong; Carl L Berg Journal: Liver Transpl Date: 2009-02 Impact factor: 5.799
Authors: Sudeep Tanwar; Shahid A Khan; Vijay Paul Bob Grover; Catherine Gwilt; Belinda Smith; Ashley Brown Journal: World J Gastroenterol Date: 2009-11-28 Impact factor: 5.742