Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation

Sophia Schmitz; Georg Lurje; Florian Ulmer; Anne Andert; Philipp Bruners; Maximilian Schulze-Hagen; Ulf Neumann; Wenzel Schoening

doi:10.1016/j.hbpd.2019.01.004

Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation

Sophia Schmitz, Georg Lurje, Florian Ulmer, Anne Andert, Philipp Bruners, Maximilian Schulze-Hagen, Ulf Neumann, Wenzel Schoening^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, "extended critera donor (ECD) organs" are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary.

Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses.

Results: One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P=0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P= 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P= 0.663).

Conclusions: Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option. (C) 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

Original language	English
Pages (from-to)	228-236
Number of pages	9
Journal	Hepatobiliary & Pancreatic Diseases International
Volume	18
Issue number	3
DOIs	https://doi.org/10.1016/j.hbpd.2019.01.004
Publication status	Published - Jun 2019

Keywords

Hepatocellular carcinoma
Liver transplantation
Therapeutic embolization
Liver neoplasms
Organ transplantation
TRANSARTERIAL CHEMOEMBOLIZATION
MANAGEMENT
RESECTION
SURVIVAL
CRITERIA
IMPACT
LIST
SIZE

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10.1016/j.hbpd.2019.01.004

Cite this

@article{97c1e874892e4912a7c24b2e47684d6a,

title = "Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation",

abstract = "Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, {"}extended critera donor (ECD) organs{"} are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary.Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses.Results: One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P=0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P= 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P= 0.663).Conclusions: Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option. (C) 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.",

keywords = "Hepatocellular carcinoma, Liver transplantation, Therapeutic embolization, Liver neoplasms, Organ transplantation, TRANSARTERIAL CHEMOEMBOLIZATION, MANAGEMENT, RESECTION, SURVIVAL, CRITERIA, IMPACT, LIST, SIZE",

author = "Sophia Schmitz and Georg Lurje and Florian Ulmer and Anne Andert and Philipp Bruners and Maximilian Schulze-Hagen and Ulf Neumann and Wenzel Schoening",

note = "Publisher Copyright: {\textcopyright} 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China",

year = "2019",

month = jun,

doi = "10.1016/j.hbpd.2019.01.004",

language = "English",

volume = "18",

pages = "228--236",

journal = "Hepatobiliary & Pancreatic Diseases International",

issn = "1499-3872",

publisher = "Elsevier Science",

number = "3",

}

TY - JOUR

T1 - Loco-regional hepatocellular carcinoma treatment services as a bridge to liver transplantation

AU - Schmitz, Sophia

AU - Lurje, Georg

AU - Ulmer, Florian

AU - Andert, Anne

AU - Bruners, Philipp

AU - Schulze-Hagen, Maximilian

AU - Neumann, Ulf

AU - Schoening, Wenzel

PY - 2019/6

Y1 - 2019/6

N2 - Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, "extended critera donor (ECD) organs" are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary.Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses.Results: One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P=0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P= 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P= 0.663).Conclusions: Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option. (C) 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

AB - Background: Liver transplantation remains the main curative treatment option for hepatocellular carcinoma (HCC) patients. In the Eurotransplant area Milan criteria are used to assign priority extra points (exceptional MELD, exMELD) for patients on the waiting list. To prevent patients from tumor progression, loco-regional (neoadjuvant) treatment (LRT) is used. For patients unlikely to timely receive an organ via primary allocation, "extended critera donor (ECD) organs" are used. The present study aimed to investigate the survival after LT with a strategy of minimizing waiting list dropouts by using LRT for bridging and transplanting ECD organs if possible and necessary.Methods: Between October 2010 and May 2015, 50 liver transplants for HCC were included in this retrospective study. Of those, 42 (84%) met the Milan criteria according to the preoperative radiological examination. Forty-one patients (82%) received LRT. The waiting time was analyzed according to LRT. Kaplan-Meier curves with log-rank statistics were used for survival analyses.Results: One- and five-year overall survival within Milan criteria was 94.3% and 83.7% compared with 91.7% and 67.9% beyond Milan criteria, though statistical significance was not reached (P = 0.487). LRT had no impact on overall survival (P=0.629). Median waiting time was shorter if no LRT was performed (4.6 months vs. 1.5 months, P= 0.006) and there were no cases of waiting list dropouts. Using ECD organs had no impact on overall survival (P= 0.663).Conclusions: Patients with an expected waiting time to transplantation of >6 months could be successfully treated with LRT as a bridge to transplant. Overall and disease-free survival for patients within and beyond Milan criteria was comparable and the use of ECD organs in this cohort of HCC patients proved to be a safe option. (C) 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

KW - Hepatocellular carcinoma

KW - Liver transplantation

KW - Therapeutic embolization

KW - Liver neoplasms

KW - Organ transplantation

KW - TRANSARTERIAL CHEMOEMBOLIZATION

KW - MANAGEMENT

KW - RESECTION

KW - SURVIVAL

KW - CRITERIA

KW - IMPACT

KW - LIST

KW - SIZE

U2 - 10.1016/j.hbpd.2019.01.004

DO - 10.1016/j.hbpd.2019.01.004

M3 - Article

C2 - 30718181

SN - 1499-3872

VL - 18

SP - 228

EP - 236

JO - Hepatobiliary & Pancreatic Diseases International

JF - Hepatobiliary & Pancreatic Diseases International

IS - 3

ER -