1. Survival after Liver Transplant: Influence of Progression of Disease and of Restoration of the "Milan" Criteria in Patients with Hepato-cellular Carcinoma undergoing Down-staging Procedures.
- Author
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Giacomoni A, Di Sandro S, Donadon M, Lauterio A, Belli L, Mangoni I, Mihaylov P, Concone G, and De Carlis L
- Subjects
- Adult, Aged, Carcinoma, Hepatocellular pathology, Cohort Studies, Disease Progression, Disease-Free Survival, Female, Humans, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Survival Rate, Treatment Outcome, Waiting Lists, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Liver Transplantation, Patient Selection
- Abstract
Background/aims: Selection of patients with hepa- to-cellular carcinoma for liver transplantation is gen- erally performed according to the so-called Milan cri- teria. The aim of this study was to learn whether, after down-staging loco-regional therapies, patients origi- nally non-fulfilling the MC (Milan-OUT) meet these criteria (Milan-IN)., Methodology: Between January 2000 and December 2008, 172 patients with HCC re- ceived LT at our Department. Of these, 142 were sub- jected to DS before LT., Results: Of the 142 patients who received DS, 115 (81%) were Milan-IN and 27 (19%) were Milan-OUT at the time of their enrollment in the waiting list for LT. After a median follow-up of 50 months, overall 1-, 3-, and 5-year survival and dis- ease recurrence-free survival were not significantly different., Conclusions: Patients with Milan-OUT HCC can be successfully subjected to LT when they fulfill the MC after being subjected to DS. Imaging progres- sion while on the waiting list is a strong predictor of high rates of HCC recurrence even in patients meet- ing the MC. Lack of imaging progression seems to be a strong predictor of positive LT outcome and should be added to the eligibility criteria for the assessment of LT candidates with HCC.
- Published
- 2015