Downstaging prior to liver transplantation for hepatocellular carcinoma: advisable but at the price of an increased risk of cancer recurrence - a retrospective study

Transplant International : Official Journal of the European Society for Organ Transplantation
Christian TosoNorman M Kneteman

Abstract

The use of downstaging prior to liver transplantation for hepatocellular carcinoma (HCC) still needs refinement. This study included patients with HCC listed for transplantation according to the Total Tumour Volume (TTV) ≤115 cm3 and alpha fetoprotein (AFP) ≤400 ng/ml criteria, with and without previous downstaging. Overall, 455 patients were listed, and 286 transplanted. Post-transplant follow-up was 38.5 ± 1.7 months. Patients downstaged to TTV115/AFP400 (n = 29) demonstrated similar disease-free survivals (DFS, 74% vs. 80% at 5 years, P = 0.949), but a trend to more recurrences (14% vs. 5.8%, P = 0.10) than those always within TTV115/AFP400 (n = 257). Similarly, patients downstaged to Milan criteria (n = 80) demonstrated similar DFS (76% vs. 86% at 5 years, P = 0.258), but more recurrences (11% vs. 1.7%, P = 0.001) than those always within Milan (n = 177). Among patients downstaged to Milan, those originally beyond TTV115/AFP400 (n = 27) had similar outcomes as those originally beyond Milan, but within TTV115/AFP400 (n = 53). However, the likelihood of being within Milan at transplant was lower for patients with more advanced original HCCs (P < 0.0001). Overall, despite an expected increase in post-transplant HCC recurrence,...Continue Reading

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Citations

Mar 7, 2019·Digestive Diseases and Sciences·Trevor W ReichmanNarendra R Battula
Sep 15, 2019·Annals of Surgical Oncology·Michał GrątKrzysztof Zieniewicz
Aug 10, 2019·Current Opinion in Organ Transplantation·Ashley J P LimkemannGonzalo Sapisochin
Jan 30, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·Michela AssalinoChristian Toso
Jul 15, 2020·Expert Review of Gastroenterology & Hepatology·Michele FinottiUmberto Cillo
Nov 15, 2019·Transplantation Direct·Julia HerrerasMarina Berenguer
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Feb 27, 2021·Transplantation Reviews·Guangjiang JiangXiao Xu
Oct 4, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Sepideh GholamiSusanne G Warner

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