Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region

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dc.contributor.authorPiñero, Federico
dc.contributor.authorAnders, Margarita
dc.contributor.authorBoin, Ilka F.
dc.contributor.authorChagas, Aline
dc.contributor.authorQuiñonez, Emilio
dc.contributor.authorMarciano, Sebastián
dc.contributor.authorVilatobá, Mario
dc.contributor.authorSantos, Luisa
dc.contributor.authorHoyos Duque, Sergio
dc.contributor.authorSoares Lima, Agnaldo
dc.contributor.authorMenendez, Josemaría
dc.contributor.authorPadilla, Martín
dc.contributor.authorPoniachik, Jaime
dc.contributor.authorZapata, Rodrigo
dc.contributor.authorSoza, Alejandro
dc.contributor.authorMaraschio, Martín
dc.contributor.authorChong Menéndez, Ricardo
dc.contributor.authorMuñoz, Linda
dc.contributor.authorArufe, Diego
dc.contributor.authorFigueroa, Rodrigo
dc.contributor.authorAtaide, Elaine Cristina de
dc.contributor.authorMaccali, Claudia
dc.contributor.authorVergara Sandoval, Rodrigo
dc.contributor.authorBermudez, Carla
dc.contributor.authorPodesta, Luis G.
dc.contributor.authorMcCormack, Lucas
dc.contributor.authorVarón, Adriana
dc.contributor.authorGadano, Adrián
dc.contributor.authorMattera, Juan
dc.contributor.authorVillamil, Federico
dc.contributor.authorRubinstein, Fernando
dc.contributor.authorCarrilho, Flair
dc.contributor.authorSilva, Marcelo
dc.date.accessioned2022-05-06T14:27:44Z
dc.date.available2022-05-06T14:27:44Z
dc.date.issued2021
dc.description.abstractThis 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).es
dc.description.versionVersión Publicadaes
dc.identifier.citationPiñero F, Anders M, Boin IF, Chagas A, Quiñonez E, Marciano S, Vilatobá M, Santos L, Hoyos Duque S, Lima AS, Menendez J, Padilla M, Poniachik J, Zapata R, Soza A, Maraschio M, Chong Menéndez R, Muñoz L, Arufe D, Figueroa R, de Ataide EC, Maccali C, Vergara Sandoval R, Bermudez C, Podesta LG, McCormack L, Varón A, Gadano A, Mattera J, Villamil F, Rubinstein F, Carrilho F, Silva M. Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region. Transpl Int. 2021 Jan;34(1):97-109. doi: 10.1111/tri.13767. PMID: 33040420.es
dc.identifier.urihttps://doi.org/10.1111/tri.13767es
dc.identifier.urihttp://hdl.handle.net/11447/6058
dc.language.isoenes
dc.subjectAllocationes
dc.subjectHepatocellular carcinomaes
dc.subjectLiver transplantationes
dc.subjectSelectiones
dc.titleLiver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality regiones
dc.typeArticlees
dcterms.sourceTransplant Internationales

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