BACKGROUND: Liver transplantation (OLT) represents the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver disease. However, because of organ scarcity, alternative options must be explored, such as the use of extended criteria donor (ECD) grafts. PATIENTS AND METHODS: We reviewed data of transplanted HCC patients using ECD grafts. Statistical analysis included uni- and multivariate Cox proportional hazards regression and survival analysis using the Kaplan-Meier method with the log-rank test. RESULTS: Over a 6-year period, we transplanted 53 HCC patients with ECD grafts. The 38 men and 15 women showed a mean age of 56.3 ± 8.26 years. Thirty-four patients underwent a bridging treatment before OLT. Thirty-eight patients (72%) were outside the Milan criteria. The median value for alpha fetoprotein (AFP) level was 30.7 ng/dL. Pathologic tumor grade was G1 (n = 4), G2 (n = 32), G3 (n = 6), or Gx (n = 11). Median follow-up time was 23 months (range, 9-75). Overall 3- and 5- year patient survivals were 79% and 74%, respectively. The 5-year survivals for patients within or outside the Milan criteria were 87% versus 69%, respectively (P = .3728). Donor transaminases and post-OLT hemodialysis were prognostic factors for patient survival upon mutivariate regression analysis (P = .0043 and P = .0003, respectively). CONCLUSION: OLT with ECD grafts constitutes an additional option for patients with HCC and cirrhosis, particularly subjects outside the Milan criteria. The risk- benefit ratio in these instances should be evaluated on a case-by-case basis.
BACKGROUND: Liver transplantation (OLT) represents the treatment of choice for small hepatocellular carcinomas (HCC) in patients with end-stage liver disease. However, because of organ scarcity, alternative options must be explored, such as the use of extended criteria donor (ECD) grafts. PATIENTS AND METHODS: We reviewed data of transplanted HCC patients using ECD grafts. Statistical analysis included uni- and multivariate Cox proportional hazards regression and survival analysis using the Kaplan-Meier method with the log-rank test. RESULTS: Over a 6-year period, we transplanted 53 HCC patients with ECD grafts. The 38 men and 15 women showed a mean age of 56.3 ± 8.26 years. Thirty-four patients underwent a bridging treatment before OLT. Thirty-eight patients (72%) were outside the Milan criteria. The median value for alpha fetoprotein (AFP) level was 30.7 ng/dL. Pathologic tumor grade was G1 (n = 4), G2 (n = 32), G3 (n = 6), or Gx (n = 11). Median follow-up time was 23 months (range, 9-75). Overall 3- and 5- year patient survivals were 79% and 74%, respectively. The 5-year survivals for patients within or outside the Milan criteria were 87% versus 69%, respectively (P = .3728). Donor transaminases and post-OLT hemodialysis were prognostic factors for patient survival upon mutivariate regression analysis (P = .0043 and P = .0003, respectively). CONCLUSION: OLT with ECD grafts constitutes an additional option for patients with HCC and cirrhosis, particularly subjects outside the Milan criteria. The risk- benefit ratio in these instances should be evaluated on a case-by-case basis.
Authors: Georgios C Sotiropoulos; Eleftherios Spartalis; Nikolaos Machairas; Andreas Paul; Massimo Malagó; Markus Neuhäuser Journal: Ann Gastroenterol Date: 2018-07-27