Risk assessment in liver transplantation for hepatocellular carcinoma: long-term follow-up of a two-center experience

医学 肝细胞癌 肝移植 内科学 米兰标准 单中心 比例危险模型 胃肠病学 接收机工作特性 人口 移植 肿瘤科 外科 环境卫生
作者
Chase J. Wehrle,Roma Raj,Marianna Maspero,Sangeeta Satish,Bijan Eghtesad,Alejandro Pita,Jaekeun Kim,Mazhar Khalil,Esteban Calderon,Danny Orabi,Bobby Zervos,Jamak Modaresi Esfeh,Maureen Whitsett Linganna,Teresa Diago‐Uso,Masato Fujiki,Cristiano Quintini,Choonhyuck David Kwon,Charles C. Miller,Antonio Pinna,Federico Aucejo,Koji Hashimoto,Andrea Schlegel
出处
期刊:International Journal of Surgery [Wolters Kluwer]
标识
DOI:10.1097/js9.0000000000001104
摘要

Liver transplantation (LT) is a well-established treatment for hepatocellular carcinoma (HCC), but there are ongoing debates regarding outcomes and selection. This study examines the experience of LT for HCC at a high-volume center.A prospectively maintained database was used to identify HCC patients undergoing LT from 2000-2020 with>3 years follow-up. Data was obtained from the center database and electronic medical records. The Metroticket 2.0 HCC-specific five-year survival scale was calculated for each patient. Kaplan-Meier and Cox-regression analyses were employed assessing survival between groups based on Metroticket score and individual donor and recipient risk factors.569 patients met criteria. Median follow-up was 96.2 months (8.12 y; IQR 59.9-147.8). Three-year recurrence-free (RFS) and overall survival (OS) were 88.6% (n=504) and 86.6% (n=493). Five-year RFS and OS were 78.9% (n=449) and 79.1% (n=450). Median Metroticket 2.0 score was 0.9 (IQR 0.9-0.95). Tumor size>3 cm (P=0.012), increasing tumor number on imaging (P=0.001) and explant pathology (P<0.001) was associated with recurrence. Transplant within Milan (P<0.001) or UCSF-criteria (P<0.001) had lower recurrence rates. Increasing AFP-values were associated with more HCC-recurrence (P<0.001) and reduced OS (P=0.008). Chemoembolization was predictive of recurrence in the overall population (P=0.043) and in those outside Milan criteria (P=0.038). A receiver-operator curve using Metroticket 2.0 identified an optimal cut-off of projected survival>87.5% for predicting recurrence. This cut-off was able to predict RFS (P<0.001) in the total cohort and predict both, RFS (P=0.007) and OS (P=0.016) outside-Milan. Receipt of donation after brain death (DBD) grafts (55/478, 13%) or living-donor grafts (3/22, 13.6%) experienced better survival rates compared to donation after cardiac death (DCD) grafts (n=15/58, 25.6%, P=0.009). Donor age was associated with a higher HCC-recurrence (P=0.006). Both total ischemia time (TIT)>6hours (P=0.016) and increasing TIT correlated with higher HCC-recurrence (P=0.027). The use of DCD-grafts for outside-Milan candidates was associated with increased recurrence (P=0.039) and reduced survival (P=0.033).This large two-center analysis confirms favorable outcomes after LT for HCC. Tumor size and number, pre-transplant AFP, and Milan criteria remain important recipient HCC-risk factors. A higher donor risk (i.e., donor age, DCD-grafts, ischemia time) was associated with poorer outcomes.

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
Goodluck完成签到,获得积分10
1秒前
KK发布了新的文献求助10
2秒前
大气的一德完成签到,获得积分20
4秒前
wawaeryu发布了新的文献求助50
4秒前
4秒前
4秒前
充电宝应助Chen二月三石采纳,获得10
4秒前
abcdefg完成签到,获得积分10
5秒前
小白完成签到,获得积分20
5秒前
feiying88发布了新的文献求助10
6秒前
zcvxd完成签到,获得积分10
7秒前
7秒前
枫影发布了新的文献求助10
8秒前
8秒前
8秒前
斯文败类应助QiangWang1991采纳,获得10
8秒前
庞扬发布了新的文献求助20
8秒前
小白发布了新的文献求助30
8秒前
Ava应助WTX采纳,获得10
9秒前
9秒前
苏silence发布了新的文献求助10
10秒前
10秒前
10秒前
11秒前
11秒前
小冰棍完成签到,获得积分10
11秒前
量子星尘发布了新的文献求助10
12秒前
12秒前
大脸完成签到,获得积分10
13秒前
wawaeryu完成签到,获得积分10
13秒前
13秒前
莉123发布了新的文献求助10
13秒前
14秒前
苏打发布了新的文献求助10
14秒前
共享精神应助顺心的惜蕊采纳,获得10
14秒前
15秒前
桐桐应助Kalmia采纳,获得10
15秒前
15秒前
星星子发布了新的文献求助10
16秒前
火星发布了新的文献求助20
16秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3974882
求助须知:如何正确求助?哪些是违规求助? 3519431
关于积分的说明 11198315
捐赠科研通 3255698
什么是DOI,文献DOI怎么找? 1797904
邀请新用户注册赠送积分活动 877237
科研通“疑难数据库(出版商)”最低求助积分说明 806219