The effect of graft type on mortality in liver transplantation for hepatocellular carcinoma.
Ann Transplant
; 20: 175-85, 2015 Mar 30.
Article
em En
| MEDLINE
| ID: mdl-25819218
ABSTRACT
BACKGROUND:
Liver transplantation (LT) with living-donor (LD-P) and deceased-donor (DD-P) partial grafts for hepatocellular carcinoma (HCC) may be associated with worse outcomes. Using the United Network for Organ Sharing (UNOS), we aimed to (1) examine the risk of mortality in LT for HCC, (2) to establish if this risk is affected by partial graft use, and (3) to determine if this effect is mitigated by improved tumor-associated risk stratification. MATERIAL ANDMETHODS:
All first-time adult LT recipients were analyzed (3/2002-12/2012), including 2,353 LD-P, 727 DD-P, and 47,833 DD whole (DD-W) grafts. Cox proportional hazards models were used to examine the risk of mortality given HCC. Interaction/subset analyses were used to examine the effect of tumor-risk and graft-type on outcome. Presence of an HCC exception and low alpha-fetoprotein (AFP) level (<66 ng/mL) were considered favorable.RESULTS:
Overall, HCC was associated with an increased mortality risk compared to the absence of HCC (HR 1.21 [1.15-1.27]), and the use of partial grafts was noted to further intensify this risk. However, HCC with a favorable risk profile had more comparable outcomes to patients without HCC and this finding was similar across all graft-types (Given LD-P HR 1.14 [0.76-1.73]; Given DD-P HR1.05 [0.71-1.56]; Given DD-W HR1.08 [1.02-1.14]). On subset analysis, all graft types had similar outcomes given either favorable-risk HCC or the absence of HCC.CONCLUSIONS:
There is no significant difference in outcomes between whole and partial grafts given (1) patients with HCC with a favorable risk-profile or (2) patients without HCC.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doadores de Tecidos
/
Transplante de Fígado
/
Carcinoma Hepatocelular
/
Neoplasias Hepáticas
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Ann Transplant
Assunto da revista:
TRANSPLANTE
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Estados Unidos