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Preliminary results of liver transplantation for hepatocellular carcinoma among allocation organ policy strategies, neoadjuvant treatments, and intention-to-treat analysis.
Transplant Proc. 2008 Jul-Aug; 40(6):1972-3.TP

Abstract

We retrospectively evaluated the impact of our strategy for patients with hepatocellular carcinoma (HCC) according to an intention-to-treat analysis and drop-out probability. We evaluated only patients within the Milan criteria. We analyzed the outcomes of neoadjuvant strategies for HCC, organ allocation policy, and systematic application of strategies to increase the deceased donor pool as the current tendency to expand transplantability criteria for those patients. Kaplan-Meier survival probability rates at 1, 3, and 5 years according to an intention-to-treat analysis were 87.02%, 74.53%, and 65.93% for transplanted patients (n=108), and 50%, 14.29%, and 14.29% for the excluded or waiting list group (n=13), respectively (P< .0001). Drop-out risk at 3, 6, and 12 months was 2.40%, 8.59%, and 16.54%, respectively. During the same period, the mortality probability rates at 3, 6, and 12 months among patients without HCC awaiting orthotopic liver transplantation (OLT) were 3.60%, 9.50%, and 18.34%, respectively. Drop-out rate was lower among patients treated before OLT (P< .0001). On the basis of the neoadjuvant treatment results to reduce drop-out risk, we suggest avoiding the high priority for the HCC cohort, particularly within the first 6 months from entrance on the waiting list, because this approach can reduce the chances of patients with end-stage liver disease (ESLD) alone.

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Authors+Show Affiliations

Andorno E
Department of General Surgery and Organ Transplantation, S. Martino Hospital, Genoa, Italy.
Bottino G
No affiliation info available
Morelli N
No affiliation info available
Casaccia M
No affiliation info available
Gelli M
No affiliation info available
Piredda D
No affiliation info available
Immordino G
No affiliation info available
Ferrante R
No affiliation info available
Nardi I
No affiliation info available
Troilo BM
No affiliation info available
Di Domenico S
No affiliation info available
Ravazzoni F
No affiliation info available
Valente U
No affiliation info available

MeSH

Carcinoma, HepatocellularChemoembolization, TherapeuticHealth PolicyHumansLiver NeoplasmsLiver TransplantationNeoplasm MetastasisPatient SelectionResource AllocationRetrospective StudiesSurvival AnalysisWaiting Lists

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18675103

Citation

Andorno, E, et al. "Preliminary Results of Liver Transplantation for Hepatocellular Carcinoma Among Allocation Organ Policy Strategies, Neoadjuvant Treatments, and Intention-to-treat Analysis." Transplantation Proceedings, vol. 40, no. 6, 2008, pp. 1972-3.
Andorno E, Bottino G, Morelli N, et al. Preliminary results of liver transplantation for hepatocellular carcinoma among allocation organ policy strategies, neoadjuvant treatments, and intention-to-treat analysis. Transplant Proc. 2008;40(6):1972-3.
Andorno, E., Bottino, G., Morelli, N., Casaccia, M., Gelli, M., Piredda, D., Immordino, G., Ferrante, R., Nardi, I., Troilo, B. M., Di Domenico, S., Ravazzoni, F., & Valente, U. (2008). Preliminary results of liver transplantation for hepatocellular carcinoma among allocation organ policy strategies, neoadjuvant treatments, and intention-to-treat analysis. Transplantation Proceedings, 40(6), 1972-3. https://doi.org/10.1016/j.transproceed.2008.05.061
Andorno E, et al. Preliminary Results of Liver Transplantation for Hepatocellular Carcinoma Among Allocation Organ Policy Strategies, Neoadjuvant Treatments, and Intention-to-treat Analysis. Transplant Proc. 2008 Jul-Aug;40(6):1972-3. PubMed PMID: 18675103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preliminary results of liver transplantation for hepatocellular carcinoma among allocation organ policy strategies, neoadjuvant treatments, and intention-to-treat analysis. AU - Andorno,E, AU - Bottino,G, AU - Morelli,N, AU - Casaccia,M, AU - Gelli,M, AU - Piredda,D, AU - Immordino,G, AU - Ferrante,R, AU - Nardi,I, AU - Troilo,B M, AU - Di Domenico,S, AU - Ravazzoni,F, AU - Valente,U, PY - 2008/8/5/pubmed PY - 2008/10/1/medline PY - 2008/8/5/entrez SP - 1972 EP - 3 JF - Transplantation proceedings JO - Transplant Proc VL - 40 IS - 6 N2 - We retrospectively evaluated the impact of our strategy for patients with hepatocellular carcinoma (HCC) according to an intention-to-treat analysis and drop-out probability. We evaluated only patients within the Milan criteria. We analyzed the outcomes of neoadjuvant strategies for HCC, organ allocation policy, and systematic application of strategies to increase the deceased donor pool as the current tendency to expand transplantability criteria for those patients. Kaplan-Meier survival probability rates at 1, 3, and 5 years according to an intention-to-treat analysis were 87.02%, 74.53%, and 65.93% for transplanted patients (n=108), and 50%, 14.29%, and 14.29% for the excluded or waiting list group (n=13), respectively (P< .0001). Drop-out risk at 3, 6, and 12 months was 2.40%, 8.59%, and 16.54%, respectively. During the same period, the mortality probability rates at 3, 6, and 12 months among patients without HCC awaiting orthotopic liver transplantation (OLT) were 3.60%, 9.50%, and 18.34%, respectively. Drop-out rate was lower among patients treated before OLT (P< .0001). On the basis of the neoadjuvant treatment results to reduce drop-out risk, we suggest avoiding the high priority for the HCC cohort, particularly within the first 6 months from entrance on the waiting list, because this approach can reduce the chances of patients with end-stage liver disease (ESLD) alone. SN - 0041-1345 UR - https://www.unboundmedicine.com/medline/citation/18675103/Preliminary_results_of_liver_transplantation_for_hepatocellular_carcinoma_among_allocation_organ_policy_strategies_neoadjuvant_treatments_and_intention_to_treat_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(08)00717-3 DB - PRIME DP - Unbound Medicine ER -