NDLI: Total tumor volume and alpha-fetoprotein for selection of transplant candidates with hepatocellular carcinoma: A prospective validation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Toso, Christian Meeberg, Glenda Hernandez-Alejandro, Roberto Dufour, Jean-François Marotta, Paul Majno, Pietro Kneteman, Norman M.
Description	Country affiliation: Switzerland Author Affiliation: Toso C ( Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.); Meeberg G ( Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.); Hernandez-Alejandro R ( Multi-Organ Transplant Program, London Health Sciences Center, The University of Western Ontario, London, Ontario, Canada.); Dufour JF ( University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland.); Marotta P ( Multi-Organ Transplant Program, London Health Sciences Center, The University of Western Ontario, London, Ontario, Canada.); Majno P ( Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.); Kneteman NM ( Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.)
Abstract	UNLABELLED: The selection of liver transplantation (LT) candidates with hepatocellular carcinoma (HCC) is currently validated based on Milan criteria. The use of extended criteria has remained a matter of debate, mainly because of the absence of prospective validation. The present prospective study recruited patients according to the previously proposed total tumor volume (TTV; ≤115 cm(3) )/alpha-fetoprotein (AFP; ≤400 ng/mL) score. Patients with AFP >400 ng/mL were excluded, and, as such, the Milan group was modified to include only patients with AFP <400 ng/mL; these patients were compared to patients beyond Milan, but within TTV/AFP. From January 2007 to March 2013, 233 patients with HCC were listed for LT. Of them, 195 patients were within Milan and 38 beyond Milan, but within TTV/AFP. The average follow-up from listing was 33.9 ± 24.9 months. Risk of dropout was higher for patients beyond Milan, but within TTV/AFP (16 of 38; 42.1%), than for those within Milan (49 of 195 [25.1%]; P = 0.033). In parallel, intent-to-treat survival from listing was lower in patients beyond Milan (53.8% vs. 71.6% at 4 years; P < 0.001). After a median waiting time of 8 months, 166 patients were transplanted, 134 within Milan criteria, and 32 beyond Milan but within TTV/AFP. They demonstrated acceptable and similar recurrence rates (4.5% vs. 9.4%; P = 0.138) and post-transplant survivals (78.7% vs. 74.6% at 4 years; P = 0.932). CONCLUSION: Based on the present prospective study, HCC LT candidate selection could be expanded to the TTV (≤115 cm(3) )/AFP (≤400 ng/mL) criteria in centers with at least 8-month waiting time. An increased risk of dropout on the waiting list can be expected, but with equivalent and satisfactory post-transplant survival.
File Format	HTM / HTML
ISSN	02709139
Issue Number	1
Volume Number	62
e-ISSN	15273350
Journal	Hepatology
Language	English
Publisher	Wiley
Publisher Date	2015-07-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Hepatology Carcinoma, Hepatocellular Surgery Liver Neoplasms Liver Transplantation Statistics & Numerical Data Liver Pathology Alpha-fetoproteins Metabolism Blood Female Humans Male Middle Aged Patient Selection Prospective Studies Journal Article Multicenter Study Research Support, Non-u.s. Gov't Validation Studies
Content Type	Text
Resource Type	Article
Subject	Hepatology

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