Browsing by Author "Chagas, Aline"
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Publication AFP score and metroticket 2.0 perform similarly and could be used in a “within-ALL” clinical decision tool(2022) Piñero, Federico; Costentin, Charlotte; Degroote, Helena; FSF., Andrea; Boudjema, Karim; Baccaro, Cinzia; Chagas, Aline; Bachellier, Philippe; Ettorre, Giuseppe; Poniachik, Jaime; Muscari, Fabrice; Dibenedetto, Fabrizio; Hoyos, Sergio; Salame, Ephrem; Cillo, Umberto; Marciano, Sebastián; Vanlemmens, Claire; Fagiuoli, Stefano; Carrilho, Flair; Cherqui, Daniel; Burra, Patrizia; Van Vlierberghe, Hans; Lai, Quirino; Silva, Marcelo; Rubinstein, Fernando; Duvoux, ChristopheBackground & aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model's original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell's adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model's original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p <0.0001). At last tumor reassessment before LT, c-statistics did not significantly differ between the two composite models, either as original or threshold versions, for recurrence (0.72 vs. 0.68; p = 0.06), HCC survival, and overall survival after LT. We observed predictive gaps and overlaps between the model's thresholds, and no significant gain on reclassification. Patients meeting both models ("within-ALL") at last tumor reassessment presented the lowest 5-year cumulative incidence of HCC recurrence (7.7%; 95% CI 5.1-11.5) and higher 5-year post-LT survival (70.0%; 95% CI 64.9-74.6). Conclusions: In this multicenter cohort, Metroticket 2.0 and the AFP score demonstrated a similar ability to predict HCC recurrence post-LT. The combination of these composite models might be a promising clinical approach. Impact and implications: Composite models were recently proposed for the selection of liver transplant (LT) candidates among individuals with hepatocellular carcinoma (HCC). We found that both the AFP score and Metroticket 2.0 predicted post-LT HCC recurrence and survival better than Milan criteria; the Metroticket 2.0 did not result in better reclassification for transplant selection compared to the AFP score, with predictive gaps and overlaps between the two models; patients who met low-risk thresholds for both models had the lowest 5-year recurrence rate. We propose prospectively testing the combination of both models, to further optimize the LT selection process for candidates with HCC.Item Direct-Acting Antivirals and Hepatocellular Carcinoma: No Evidence of Higher Wait-List Progression or Posttransplant Recurrence(2020) Piñero, Federico; Boin, Ilka; Chagas, Aline; Quiñonez, Emilio; Marciano, Sebastián; Vilatobá, Mario; Santos, Luisa; Anders, Margarita; Hoyos Duque, Sergio; Soares Lima, Agnaldo; Menendez, Josemaría; Padilla, Martín; Poniachik, Jaime; Zapata, Rodrigo; Maraschio, Martín; Chong Menéndez, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Mendizabal, Manuel; Hurtado Gomez, Sahara; Stucchi, Raquel; Maccali, Claudia; Vergara Sandoval, Rodrigo; Bermudez, Carla; McCormack, Lucas; Varón, Adriana; Gadano, Adrián; Mattera, Juan; Rubinstein, Fernando; Carrilho, Flair; Silva, MarceloThe association between direct-acting antivirals (DAAs) and hepatocellular carcinoma (HCC) wait-list progression or its recurrence following liver transplantation (LT) remains uncertain. We evaluated the impact of DAAs on HCC wait-list progression and post-LT recurrence. This Latin American multicenter retrospective cohort study included HCC patients listed for LT between 2012 and 2018. Patients were grouped according to etiology of liver disease: hepatitis C virus (HCV) negative, HCV+ never treated with DAAs, and HCV+ treated with DAAs either before or after transplantation. Multivariate competing risks models were conducted for both HCC wait-list progression adjusted by a propensity score matching (pre-LT DAA effect) and for post-LT HCC recurrence (pre- or post-LT DAA effect). From 994 included patients, 50.6% were HCV-, 32.9% were HCV+ never treated with DAAs, and 16.5% were HCV+ treated with DAAs either before (n = 66) or after LT (n = 98). Patients treated with DAAs before LT presented similar cumulative incidence of wait-list tumor progression when compared with those patients who were HCV+ without DAAs (26.2% versus 26.9%; P = 0.47) and a similar HCC-related dropout rate (12.1% [95% CI, 0.4%-8.1%] versus 12.9% [95% CI, 3.8%-27.2%]), adjusted for baseline tumor burden, alpha-fetoprotein values, HCC diagnosis after listing, bridging therapies, and by the probability of having received or not received DAAs through propensity score matching (subhazard ratio [SHR], 0.9; 95% CI, 0.6-1.6; P = 0.95). A lower incidence of posttransplant HCC recurrence among HCV+ patients who were treated with pre- or post-LT DAAs was observed (SHR, 0.7%; 95% CI, 0.2%-4.0%). However, this effect was confounded by the time to DAA initiation after LT. In conclusion, in this multicenter cohort, HCV treatment with DAAs did not appear to be associated with an increased wait-list tumor progression and HCC recurrence after LT.Item Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region(2021) Piñero, Federico; Anders, Margarita; Boin, Ilka F.; Chagas, Aline; Quiñonez, Emilio; Marciano, Sebastián; Vilatobá, Mario; Santos, Luisa; Hoyos Duque, Sergio; Soares Lima, Agnaldo; Menendez, Josemaría; Padilla, Martín; Poniachik, Jaime; Zapata, Rodrigo; Soza, Alejandro; Maraschio, Martín; Chong Menéndez, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Ataide, Elaine Cristina de; Maccali, Claudia; Vergara Sandoval, Rodrigo; Bermudez, Carla; Podesta, Luis G.; McCormack, Lucas; Varón, Adriana; Gadano, Adrián; Mattera, Juan; Villamil, Federico; Rubinstein, Fernando; Carrilho, Flair; Silva, MarceloThis study aimed to compare liver transplantation (LT) outcomes and evaluate the potential rise in numbers of LT candidates with hepatocellular carcinoma (HCC) of different allocation policies in a high waitlist mortality region. Three policies were applied in two Latin American cohorts (1085 HCC transplanted patients and 917 listed patients for HCC): (i) Milan criteria with expansion according to UCSF downstaging (UCSF-DS), (ii) the AFP score, and (iii) restrictive policy or Double Eligibility Criteria (DEC; within Milan + AFP score ≤2). Increase in HCC patient numbers was evaluated in an Argentinian prospective validation set (INCUCAI; NCT03775863). Expansion criteria in policy A showed that UCSF-DS [28.4% (CI 12.8-56.2)] or "all-comers" [32.9% (CI 11.9-71.3)] had higher 5-year recurrence rates compared to Milan, with 10.9% increase in HCC patients for LT. The policy B showed lower recurrence rates for AFP scores ≤2 points, even expanding beyond Milan criteria, with a 3.3% increase. Patients within DEC had lower 5-year recurrence rates compared with those beyond DEC [13.3% (CI 10.1-17.3) vs 24.2% (CI 17.4-33.1; P = 0.0006], without significant HCC expansion. In conclusion, although the application of a stricter policy may optimize the selection process, this restrictive policy may lead to ethical concerns in organ allocation (NCT03775863).Publication Performance of pre-transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout(2022) Piñero, Federico; Thompson, Marcos; Boin, Ilka; Chagas, Aline; Quiñonez, Emilio; Bermúdez, Carla; Vilatobá, Mario; Santos, Luisa; Anders, Margarita; Hoyos , Sergio; Soares, Agnaldo; Menendez, Josemaría; Padilla, Martín; Poniachik, Jaime; Zapata, Rodrigo; Maraschio, Martín; Chong, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Perales, Simone; Maccali, Claudia; Vergara, Rodrigo; McCormack, Lucas; Varón, Adriana; Marciano, Sebastián; Mattera, Juan; Carrilho, Flair; Silva, MarceloBackground & aim: Liver transplantation (LT) selection models for hepatocellular carcinoma (HCC) have not been proposed to predict waitlist dropout because of tumour progression. The aim of this study was to compare the alpha-foetoprotein (AFP) model and other pre-LT models in their prediction of HCC dropout. Methods: A multicentre cohort study was conducted in 20 Latin American transplant centres, including 994 listed patients for LT with HCC from 2012 to 2018. Longitudinal tumour characteristics, and patterns of progression were recorded at time of listing, after treatments and at last follow-up over the waitlist period. Competing risk regression models were performed, and model's discrimination was compared estimating Harrell's adapted c-statistics. Results: HCC dropout rate was significantly higher in patients beyond (24% [95% CI 16-28]) compared to those within Milan criteria (8% [95% IC 5%-12%]; p < .0001), with a SHR of 3.01 [95% CI 2.03-4.47]), adjusted for waiting list time and bridging therapies (c-index 0.63 [95% CI 0.57; 0.69). HCC dropout rates were higher in patients with AFP scores >2 (adjusted SHR of 3.17 [CI 2.13-4.71]), c-index of 0.71 (95% CI 0.65-0.77; p = .09 vs Milan). Similar discrimination power for HCC dropout was observed between the AFP score and the Metroticket 2.0 model. In patients within Milan, an AFP score >2 points discriminated two populations with a higher risk of HCC dropout (SHR 1.68 [95% CI 1.08-2.61]). Conclusions: Pre-transplant selection models similarly predicted HCC dropout. However, the AFP model can discriminate a higher risk of dropout among patients within Milan criteria.