BACKGROUND: In this study, we ask between patients with graft failure listed for retransplant and patients with hepatocellular carcinoma (HCC) outside of UCSF criteria, who has the greater survival benefit with transplantation? METHODS: This is a retrospective analysis, of liver transplant (LT) patients, done between February 2002 and December 2009 at our center. Patients were included in the "extended HCC" group if their tumor was pathologically beyond UCSF criteria at LT and in the "redo" group if they underwent LT for graft failure occurring more than 3 months after the initial LT. Extended criteria donors (ECDs) were defined as donors above 70 years old, DCD, serology positive for HCV, and split grafts. RESULTS: There were 25 redos and 37 extended HCC patients. Use of ECDs or high donor risk index organs was associated with poor outcome in both groups (P = 0.005). Overall, the extended HCC population had a much better survival than redos, both at 1 and 3 years. CONCLUSION: These two very different but high risk patient populations have very different survival rates. At a time where regulatory agencies demand more and more with regards to transplant outcomes, we think the transplant community has to reflect on whether allocation justice and fair access to transplant are respected if we start allocating organs based on outcomes.
BACKGROUND: In this study, we ask between patients with graft failure listed for retransplant and patients with hepatocellular carcinoma (HCC) outside of UCSF criteria, who has the greater survival benefit with transplantation? METHODS: This is a retrospective analysis, of liver transplant (LT) patients, done between February 2002 and December 2009 at our center. Patients were included in the "extended HCC" group if their tumor was pathologically beyond UCSF criteria at LT and in the "redo" group if they underwent LT for graft failure occurring more than 3 months after the initial LT. Extended criteria donors (ECDs) were defined as donors above 70 years old, DCD, serology positive for HCV, and split grafts. RESULTS: There were 25 redos and 37 extended HCC patients. Use of ECDs or high donor risk index organs was associated with poor outcome in both groups (P = 0.005). Overall, the extended HCC population had a much better survival than redos, both at 1 and 3 years. CONCLUSION: These two very different but high risk patient populations have very different survival rates. At a time where regulatory agencies demand more and more with regards to transplant outcomes, we think the transplant community has to reflect on whether allocation justice and fair access to transplant are respected if we start allocating organs based on outcomes.
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Authors: R M Ghobrial; R Steadman; J Gornbein; C Lassman; C D Holt; P Chen; D G Farmer; H Yersiz; N Danino; E Collisson; A Baquarizo; S S Han; S Saab; L I Goldstein; J A Donovan; K Esrason; R W Busuttil Journal: Ann Surg Date: 2001-09 Impact factor: 12.969
Authors: J F Markmann; J S Markowitz; H Yersiz; M Morrisey; D G Farmer; D A Farmer; J Goss; R Ghobrial; S V McDiarmid; R Stribling; P Martin; L I Goldstein; P Seu; C Shackleton; R W Busuttil Journal: Ann Surg Date: 1997-10 Impact factor: 12.969
Authors: Robert S Brown; Sarah H Rush; Hugo R Rosen; Alan N Langnas; Goran B Klintmalm; Douglas W Hanto; Jeffrey D Punch Journal: Am J Transplant Date: 2004 Impact factor: 8.086
Authors: J A Powelson; A B Cosimi; W D Lewis; R J Rohrer; R B Freeman; J P Vacanti; M Jonas; M I Lorber; W H Marks; J Bradley Journal: Transplantation Date: 1993-04 Impact factor: 4.939
Authors: Michał Grąt; Jan Stypułkowski; Waldemar Patkowski; Karolina M Wronka; Emil Bik; Maciej Krasnodębski; Łukasz Masior; Zbigniew Lewandowski; Michał Wasilewicz; Karolina Grąt; Marek Krawczyk; Krzysztof Zieniewicz Journal: Ann Surg Oncol Date: 2017-07-10 Impact factor: 5.344