Browsing by Author "Maccali, Claudia"
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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.Item Recurrence of hepatocellular carcinoma after liver transplantation: Prognostic and predictive factors of survival in a Latin American cohort(2021) Maccali, Claudia; Chagas, Aline L; Boin, Ilka; Quiñonez, Emilio; Marciano, Sebastián; Vilatobá, Mario; Varón, Adriana; Anders, Margarita; Hoyos Duque, Sergio; Lima, Agnaldo S; Menendez, Josemaría; Padilla-Machaca, Martín; Poniachik, Jaime; Zapata, Rodrigo; Maraschio, Martín; Chong Menéndez, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Soza, Alejandro; Fauda, Martín; Perales, Simone R; Vergara Sandoval, Rodrigo; Bermudez, Carla; Beltran, Oscar; Arenas Hoyos, Isabel; McCormack, Lucas; Mattera, Francisco Juan; Gadano, Adrián; Parente García, Jose H; Megumi Tani, Claudia; Carneiro D'Albuquerque, Luiz Augusto; Carrilho, Flair J; Silva, Marcelo; Piñero, FedericoBackground & aim: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has a poor prognosis, and the adjusted effect of different treatments on post-recurrence survival (PRS) has not been well defined. This study aims to evaluate prognostic and predictive variables associated with PRS. Methods: This Latin American multicenter retrospective cohort study included HCC patients who underwent LT between the years 2005-2018. We evaluated the effect of baseline characteristics at time of HCC recurrence diagnosis and PRS (Cox regression analysis). Early recurrences were those occurring within 12 months of LT. To evaluate the adjusted treatment effect for HCC recurrence, a propensity score matching analysis was performed to assess the probability of having received any specific treatment for recurrence. Results: From a total of 1085 transplanted HCC patients, the cumulative incidence of recurrence was 16.6% (CI 13.5-20.3), with median time to recurrence of 13.0 months (IQR 6.0-26.0). Factors independently associated with PRS were early recurrence (47.6%), treatment with sorafenib and surgery/trans-arterial chemoembolization (TACE). Patients who underwent any treatment presented "early recurrences" less frequently, and more extrahepatic metastasis. This unbalanced distribution was included in the propensity score matching, with correct calibration and discrimination (receiving operator curve of 0.81 [CI 0.72;0.88]). After matching, the adjusted effect on PRS for any treatment was HR of 0.2 (0.10;0.33); P < .0001, for sorafenib therapy HR of 0.4 (0.27;0.77); P = .003, and for surgery/TACE HR of 0.4 (0.18;0.78); P = .009. Conclusion: Although early recurrence was associated with worse outcome, even in this population, systemic or locoregional treatments were associated with better PRS.