scholarly journals Comparison of Models for Tumor Recurrence after Liver Transplantation for the Patients with Hepatocellular Carcinoma: A Multicenter Long-Term Follow-Up Study

Cancers ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1295 ◽  
Author(s):  
Young Chang ◽  
Yuri Cho ◽  
Jeong-Hoon Lee ◽  
Yun Bin Lee ◽  
Eun Ju Cho ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Overall Survival ◽  
San Francisco ◽  
Tumor Recurrence ◽  
Milan Criteria ◽  
Group Model ◽  
Donor Liver Transplantation ◽  
Cumulative Risks

Background and Aims: Several models have been developed to predict tumor the recurrence of hepatocellular carcinoma (HCC) after liver transplantation besides the conventional Milan criteria (MC), including the MoRAL score. This study aimed to compare the prognostication power of the MoRAL score to most models designed so far in the Eastern and Western countries. Methods: This study included 564 patients who underwent living donor liver transplantation (LDLT) in three large-volume hospitals in Korea. The primary and secondary endpoints were time-to-recurrence, and overall survival (OS), respectively. The performance of the MoRAL score was compared with those of other various Liver transplantation (LT) criteria, including the Milan criteria, University of California San Francisco (UCSF) criteria, up-to-seven criteria, Kyoto criteria, AFP model, total tumor volume/AFP criteria, Metroticket 2.0 model, and Weill Cornell Medical College group model. Results: The median follow-up duration was 78.1 months. Among all models assessed, the MoRAL score showed the best discrimination function for predicting the risk of tumor recurrence after LT, with c-index of 0.78, compared to other models (all p < 0.001). The MoRAL score also represented the best calibration function by Hosmer-Lemeshow test (p = 0.15). Especially in the beyond-MC sub-cohort, the MoRAL score predicted tumor recurrence (c-index, 0.80) and overall survival (OS) (c-index, 0.70) significantly better than any other models (all p < 0.001). When the MoRAL score was low (<314.8), the five-year cumulative risks of tumor recurrence and death were excellent in beyond-MC (27.8%, and 20.5%, respectively) and within-MC (16.3%, and 21.1%, respectively) sub-cohorts. Conclusions: The MoRAL score provides the most refined prognostication for predicting HCC recurrence after LDLT.

scholarly journals Liver transplantation and expanded Milan criteria: does it really work?

2012 ◽  
Vol 49 (3) ◽  
pp. 189-194 ◽  
Author(s):  
Marina Vilela Chagas Ferreira ◽  
Eleazar Chaib ◽  
Maurício Ursoline do Nascimento ◽  
Rafael Souza Fava Nersessian ◽  
Daniel Takeshi Setuguti ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
San Francisco ◽  
Orthotopic Liver Transplantation ◽  
Tumor Recurrence ◽  
Patient Survival ◽  
Milan Criteria ◽  
English Only ◽  
Significant Difference ◽  
Free Rate

CONTEXT: Orthotopic liver transplantation is an excellent treatment approach for hepatocellular carcinoma in well-selected candidates. Nowadays some institutions tend to Expand the Milan Criteria including tumor with more than 5 cm and also associate with multiple tumors none larger than 3 cm in order to benefit more patients with the orthotopic liver transplantation. METHODS: The data collected were based on the online database PubMED. The key words applied on the search were "expanded Milan criteria" limited to the period from 2000 to 2009. We excluded 19 papers due to: irrelevance of the subject, lack of information and incompatibility of the language (English only). We compiled patient survival and tumor recurrence free rate from 1 to 5-years in patients with hepatocellular carcinoma submitted to orthotopic liver transplantation according to expanded the Milan criteria from different centers. RESULTS: Review compiled data from 23 articles. Fourteen different criteria were found and they are also described in detail, however the University of California - San Francisco was the most studied one among them. CONCLUSION: Expanded the Milan criteria is a useful attempt for widening the preexistent protocol for patients with hepatocellular carcinoma in waiting-list for orthotopic liver transplantation. However there is no significant difference in patient survival rate and tumor recurrence free rate from those patients that followed the Milan criteria.

scholarly journals Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Walid El Moghazy ◽  
Samy Kashkoush ◽  
Glenda Meeberg ◽  
Norman Kneteman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Tumor Recurrence ◽  
Patient Survival ◽  
Steady Increase ◽  
Liver Transplants ◽  
Significant Difference ◽  
One Year ◽  
Over Time

Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants.Methods.We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma.Results.Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P<0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P=0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P=0.016).Conclusions.iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.

scholarly journals Clinical efficacy of locoregional therapy prior to living donor liver transplantation for hepatocellular carcinoma based on UCSF criteria

2019 ◽  
Author(s):  
Tsung-Han Wu ◽  
Chih-Hsien Cheng ◽  
Chen-Fang Lee ◽  
Ting-Jung Wu ◽  
Hong-Shiue Chou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
San Francisco ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Locoregional Therapy ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Regional Therapy ◽  
Ucsf Criteria

Abstract Background The study analyzed the loco-regional therapy outcomes prior to living donor liver transplantation (LDLT), to provide additional information for decision-making regarding therapeutic strategy for hepatocellular carcinoma (HCC) patients. Methods A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed. Patients subjected to loco-regional therapy prior to LT were grouped and the outcomes were compared. Results Overall, HCC recurrence after LDLT were detected in 38 patients (12.3%) during the follow-up period. By the end of the study, 205 patients, 6 of whom with recurrent HCC, were alive. Patients who had radiological imaging beyond the University of California at San Francisco (UCSF) criteria had significant inferior outcomes for both recurrence-free survival (RFS, p = 0.0005) and overall survival (OS, p = 0.0462) despite receiving loco-regional therapy as down-staging intention. Moreover, patients with profound tumor necrosis (TN) had a superior RFS at 3 and 5 years (97.4% and 93.8%, respectively), compared with others. Conclusion LDLT gains a satisfactory result based on the expanded UCSF criteria for HCC. However, the loco-regional therapy prior to LDLT does not seem to provide benefit unless a profound TN is noted.

scholarly journals Sirolimus Prolongs Survival after Living Donor Liver Transplantation for Hepatocellular Carcinoma Beyond Milan Criteria: A Prospective, Randomised, Open-Label, Multicentre Phase 2 Trial

2020 ◽  
Vol 9 (10) ◽  
pp. 3264
Author(s):  
Kwang-Woong Lee ◽  
Seong Hoon Kim ◽  
Kyung Chul Yoon ◽  
Jeong-Moo Lee ◽  
Jae-Hyung Cho ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Living Donor ◽  
Milan Criteria ◽  
Secondary Outcome ◽  
Open Label ◽  
Multicentre Phase ◽  
Donor Liver Transplantation ◽  
Phase 2 Trial ◽  
Hcc Recurrence

Sirolimus (SRL) has been reported to benefit patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). This study aimed to compare SRL with tacrolimus (TAC) in living-donor LT (LDLT) recipients beyond the Milan criteria. This study was initially designed to enrol 45 recipients who underwent LDLT for HCC beyond the Milan criteria. At 1 month after LT, the patients were randomly assigned to either SRL or TAC-based treatment, with both groups receiving mycophenolate mofetil. The primary outcome was three-year recurrence-free survival (RFS) and the secondary outcome was overall survival (OS). A total of 42 patients completed the study. HCC recurrence occurred in 8 of 22 (36.4%) patients in the SRL group and in 5 of 22 (25%) patients in the TAC group. No differences in RFS and OS were found between the two groups in simple comparison. The type of immunosuppressant remained a nonsignificant factor for recurrence in multivariate analysis; however, SRL significantly prolonged OS (TAC hazard ratio: 15 [1.3–172.85], p = 0.03) after adjusting for alpha-fetoprotein and positron emission tomography standardised uptake value ratio (tumour/background liver). In conclusion, SRL does not decrease HCC recurrence but prolongs OS after LDLT for HCC beyond the Milan criteria.

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