Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach

Luca Miele, Antonio Gasbarrini, Antonio Grieco, Marco Biolato, Giuseppe Marrone

Risultato della ricerca: Contributo in rivistaArticolo in rivista

1 Citazioni (Scopus)

Abstract

Hepatocellular carcinoma is becoming an increasing indication for liver transplantation, but selection and allocation of patients are challenging because of organ shortages. Conventional Milan criteria are the reference for the selection of patients worldwide, but many expanded criteria, like University of California San Francisco criteria and up-to-7 criteria, have demonstrated that survival and recurrence results are lower than those for restricted indications. Correct staging is crucial and should include surrogate markers of biological aggressiveness (a-fetoprotein, response to loco-regional treatments). Successful down-staging can select between patients with tumor burden initially beyond transplantation criteria those with a more favorable biology, provided a 3-mo stability in meeting the transplantation criteria. Allocation rules are constantly adjusted to minimize the imbalance between the priorities of candidates with and without hepatocellular carcinoma, and take into account local donor rate and waitlist dynamics. Recently, Mazzaferro et al proposed a benefit-oriented "adaptive approach", in which the selection and allocation of patients are based on their response to non-transplantation treatments: low priority for transplantation in case of complete response, high priority in case of partial response or recurrence, and no listing in case of progression beyond transplantation criteria.
Lingua originaleEnglish
pagine (da-a)3195-3204
Numero di pagine10
RivistaWorld Journal of Gastroenterology
Volume23
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • A-fetoprotein
  • Adaptive approach
  • Allocation
  • Down-staging
  • Gastroenterology
  • Milan criteria

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