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BIBTEX RIS

International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria

2021; Elsevier BV; Volume: 3; Issue: 5 Linguagem: Inglês

10.1016/j.jhepr.2021.100331

2589-5559

Helena Degroote, Federico Piñero, Charlotte Costentin, Andrea Notarpaolo, I.F.S.F. Boin, Karim Boudjéma, Cinzia Baccaro, Aline Lopes Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poníachik, Fabrice Muscari, Fabrio Di Benedetto, Sergio Hoyos Duque, Ephrem Salamé, Umberto Cillo, Adrían Gadano, Claire Vanlemmens, S. Fagiuoli, Fernando Rubinstein, Patrizia Burra, Daniel Cherqui, Marcelo Silva, Hans Van Vlierberghe, Christophe Duvoux, Karim Boudjéma, Philippe Bachellier, Filoména Conti, Olivier Scatton, Fabrice Muscari, Ephrem Salamé, Pierre Bernard, Claire Francoz, François Durand, Sébastien Dharancy, Marie-lorraine Woehl, Claire Vanlemmens, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Daniel Cherqui, Louise Barbier, Pauline Houssel‐Debry, Georges Philippe Pageaux, L. Chiche, V DELEDINGHEN, Jean Hardwigsen, J. Gugenheim, Mario Altieri, Marie Noelle Hilleret, Thomas Decaens, Daniel Cherqui, Christophe Duvoux, Federico Piñero, Aline Lopes Chagas, Paulo Everton Garcia Costa, Elaine Cristina de Ataíde, Emilio Quiñones, Sergio Hoyos Duque, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Jaime Poníachik, Alejandro Soza, Martín Padilla, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatobá, Linda E. Muñoz-Espinosa, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, Martín Fauda, Ariel González Campaña, Lucas McCormack, Juan Mattera, Adrían Gadano, Ilka S.F. Fatima Boin, José Huygens Parente Garcia, Flair José Carrilho, Marcelo Silva, Andrea Notarpaolo, Giulia Magini, L. Miglioresi, Martina Gambato, Fabrizio Di Benedetto, C. D’Ambrosio, Giuseppe Maria Ettorre, Alessandro Vitale, Patrizia Burra, S. Fagiuoli, Umberto Cillo, M. Colledan, D. Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, V. Giannelli, Adriano Pellicelli, C. Baccaro, Helena Degroote, Hans Van Vlierberghe, Eduard Callebout, Samuele Iesari, Jeroen Dekervel, Jonas Schreiber, Pirenne Jacques, Chris Verslype, Dirk Ysebaert, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Jean Delwaide, Troisi Roberto, Lerut Jan Paul,

Organ Transplantation Techniques and Outcomes

Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and 'all-comers'.This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs.From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8-55.8) and 38.2% (CI 25.4-52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The all-comers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of ≤20 ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP ≤20 ng/ml in all-comers.Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of ≤20 ng/ml might be a novel tool to optimise selection of candidates for LT.This study was registered as part of an open public registry (NCT03775863).Patients with more extended HCC (within the UCSF-DS protocol) successfully downstaged to the conventional Milan criteria do not have a higher recurrence rate after LT compared with the group remaining in the Milan criteria from listing to transplantation. Moreover, in the UCSF-DS patient group, an ALP value equal to or below 20 ng/ml at listing might be a novel tool to further optimise selection of candidates for LT.