Can the dropout risk of candidates with hepatocellular carcinoma predict survival after liver transplantation?

In the last US national conference on liver transplantation for hepatocellular carcinoma (HCC), a continuous priority score, that incorporates model for end-stage liver disease (MELD), alpha-fetoprotein and tumor size, was recommended to ensure a more equitable liver allocation. However, prioritizing highest alpha-fetoprotein levels or largest tumors may select lesions at a higher risk for recurrence; similarly, patients with higher degree of liver failure could have lower postoperative survival. Data from 300 adult HCC recipients were reviewed and the proposed HCC-MELD equation was applied to verify if it can predict post-transplantation survival. The 5-year survival and recurrence rates after transplantation were 72.8 and 13.5%, respectively. Cox regression analysis confirmed HCC-MELD as predictive of both postoperative survival and recurrence (p < 0.001). The 5-year predicted survival and recurrence rates were plotted against the HCC-MELD-based dropout probability: the higher the dropout probability while on waiting list, the lower the predicted survival after transplantation, that is worsened by hepatitis C positivity; similarly, the higher the predicted HCC recurrence rate after transplantation. The HCC priority score could predict the postoperative survival of HCC recipients and could be useful in selecting patients with greater possibilities of survival, resulting in higher post-transplantation survival rates of HCC populations.

The use of social networking to explore knowledge and attitudes toward organ donation in Italy.

BACKGROUND: Currently, online social media have become increasingly popular and can provide the opportunity to provide and acquire information regarding knowledge and attitudes toward organ donation and transplantation. To evaluate participants' knowledge about organ donation, information sources and donation principles, an on-line survey was distributed through social network in Italy. METHODS: 10584 persons were invited to respond to the questionnaire, the response rate was 22.8% and a total of 2258 complete responses were analyzed. RESULTS: The majority of participants were in favour of organ donation (94.9%), but this proportion decreased when asking for consent to donation of a family member's organs (75.2%; P<0.001). Internet represented a considerable proportion of information sources (37.2%), that were much less frequently represented by family doctors (5.6%) and school education (18.6%). Conversely, 68.5% of participants think that family doctors should provide information regarding donation and 81.9% think schools should also provide such education (P<0.001). A good knowledge about donation principles was the main factor associated with a positive attitude toward donation (P<0.001). CONCLUSION: Efforts must be aimed at involving schools and family doctors in education about donation; the use of social networks can represent a way of improving such knowledge.