Living Donor Liver Transplantation for Hepatocellular Carcinoma Within and Outside Traditional Selection Criteria-Reference-Cited by-同舟云学术

Living Donor Liver Transplantation for Hepatocellular Carcinoma Within and Outside Traditional Selection Criteria

Published:2023-07-31 Issue:1 Volume:279 Page:104-111
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Ivanics Tommy¹²³,Claasen Marco P.A.W.¹⁴,Samstein Benjamin⁵,Emond Jean C.⁶,Fox Alyson N.⁶,Pomfret Elizabeth⁷,Pomposelli James⁷,Tabrizian Parissa⁸,Florman Sander S.⁸,Mehta Neil⁹,Roberts John P.¹⁰,Emamaullee Juliet A.¹¹,Genyk Yuri¹¹,Hernandez-Alejandro Roberto¹²,Tomiyama Koji¹²,Sasaki Kazunari¹³,Hashimoto Koji¹⁴,Nagai Shunji¹⁵,Abouljoud Marwan¹⁵,Olthoff Kim M.¹⁶,Hoteit Maarouf A.¹⁷,Heimbach Julie¹⁸,Taner Timucin¹⁸,Liapakis AnnMarie H.¹⁹,Mulligan David C.²⁰,Sapisochin Gonzalo¹,Halazun Karim J.²¹,

Affiliation:

1. Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Canada

2. Department of Surgery, Henry Ford Hospital, Detroit, MI

3. Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden

4. Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands

5. Department of Surgery, Division of Liver Transplantation and Hepatobiliary Surgery, Weill Cornell Medicine, New York, NY

6. Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Medical Center, New York Presbyterian Hospital, NY

7. Department of Surgery, Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO

8. Recanati/Miller Transplantation Institute, Division of Abdominal Transplantation, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

9. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA

10. Department of Surgery, University of California, San Francisco, San Francisco, CA

11. Department of Surgery, University of Southern California, Los Angeles, CA

12. Department of Surgery, Division of Transplantation/Hepatobiliary Surgery, University of Rochester, NY

13. Department of Surgery—Abdominal Transplantation, Stanford Hospital and Clinics, Palo Alto, CA

14. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

15. Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Hospital, Detroit

16. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

17. Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

18. Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN

19. Department of Medicine, NYU Langone Health, New York, NY

20. Department of Surgery, Yale School of Medicine, New Haven, CT

21. NYU Langone Transplant Institute, NYU Langone Health, New York, NY

Abstract

Objective: To evaluate long-term oncologic outcomes of patients post–living donor liver transplantation (LDLT) within and outside standard transplantation selection criteria and the added value of the incorporation of the New York-California (NYCA) score. Background: LDLT offers an opportunity to decrease the liver transplantation waitlist, reduce waitlist mortality, and expand selection criteria for patients with hepatocellular carcinoma (HCC). Methods: Primary adult LDLT recipients between October 1999 and August 2019 were identified from a multicenter cohort of 12 North American centers. Posttransplantation and recurrence-free survival were evaluated using the Kaplan-Meier method. Results: Three hundred sixty LDLTs were identified. Patients within Milan criteria (MC) at transplantation had a 1, 5, and 10-year posttransplantation survival of 90.9%, 78.5%, and 64.1% versus outside MC 90.4%, 68.6%, and 57.7% (P = 0.20), respectively. For patients within the University of California San Francisco (UCSF) criteria, respective posttransplantation survival was 90.6%, 77.8%, and 65.0%, versus outside UCSF 92.1%, 63.8%, and 45.8% (P = 0.08). Fifty-three (83%) patients classified as outside MC at transplantation would have been classified as either low or acceptable risk with the NYCA score. These patients had a 5-year overall survival of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplantation would have been classified as a low or acceptable risk with a 5-year overall survival of 65.3%. Conclusions: Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-year rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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