P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL
Conflict of interest: No Introduction and Objectives: Hepatocellular carcinoma (HCC) with low tumor burden can be treated by liver transplantation (LT). Downstaging is a strategy to reduce tumor burden and allow transplantation. Objectives: To present the features and outcomes of patients undergoing...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268124004617 |
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| author | Juan Ignacio Marin-Zuluaga Andres Fernando Rodriguez-Gutierrez María Fernanda Saavedra-Chacón Christian Ernesto Melgar-Burbano |
| author_facet | Juan Ignacio Marin-Zuluaga Andres Fernando Rodriguez-Gutierrez María Fernanda Saavedra-Chacón Christian Ernesto Melgar-Burbano |
| author_sort | Juan Ignacio Marin-Zuluaga |
| collection | DOAJ |
| description | Conflict of interest: No Introduction and Objectives: Hepatocellular carcinoma (HCC) with low tumor burden can be treated by liver transplantation (LT). Downstaging is a strategy to reduce tumor burden and allow transplantation. Objectives: To present the features and outcomes of patients undergoing LT with a downstaging and to compare them with patients transplanted according to Milan criteria Patients / Materials and Methods: Retrospective cohort study of transplanted patients from July 2012 to January 2024 in a Colombian hospital. Downstaging was carried out in accordance with UNOS criteria. Death and recurrence of HCC were the primary outcomes. Cox proportional hazards model was adjusted for age and Child-Pugh score. Results and Discussion: 79 patients, 17 in downstaging group (DG) and 62 in Milan Group (MG). All patients had cirrhosis. Median age was 60 years and 71% were men. DG has less diabetes mellitus than MG (24% vs. 48%), less comorbidities (82% vs. 92%), better Child-Pugh, less ascites (6% vs. 50%), less encephalopathy (18% vs. 45%) and less variceal bleeding (17% vs. 32%). In DG, the median number of tumors was 2 (IQR: 1-3, 29% with just one) and in MG it was 1 (IQR: 1-1, 79% with just one). Dowstaging was performed using either TACE alone (88%) or in combination with radiofrequency ablation (22%). Liver specimens showed a high sum of tumor diameters in DG (4.8 cm vs. 3.0 cm), however, DG had less microvascular invasion (18% vs. 37%) and a better profile of tumor differentiation. Recurrence was 11.8% in DG and 8.2% in MG (p-value = 0.926, figure). In DG, there was a death rate of 6% while in MG it was 18% (p-value = 0.285). Conclusions: Downstaging appeared to be a successful strategy for LT that could be used to expand the Milan Criteria in Colombia. Less sick patients in DG (necessary for locoregional therapy), could have favored survival. |
| format | Article |
| id | doaj-art-d018917212354e58afddd3eac8406880 |
| institution | OA Journals |
| issn | 1665-2681 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj-art-d018917212354e58afddd3eac84068802025-08-20T02:20:57ZengElsevierAnnals of Hepatology1665-26812024-12-012910167810.1016/j.aohep.2024.101678P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITALJuan Ignacio Marin-Zuluaga0Andres Fernando Rodriguez-Gutierrez1María Fernanda Saavedra-Chacón2Christian Ernesto Melgar-Burbano3Hospital Pablo Tobón Uribe, Medellín, ColombiaUniversidad de Antioquia, Medellín, ColombiaUniversidad de Antioquia, Medellín, ColombiaUniversidad de Antioquia, Medellín, ColombiaConflict of interest: No Introduction and Objectives: Hepatocellular carcinoma (HCC) with low tumor burden can be treated by liver transplantation (LT). Downstaging is a strategy to reduce tumor burden and allow transplantation. Objectives: To present the features and outcomes of patients undergoing LT with a downstaging and to compare them with patients transplanted according to Milan criteria Patients / Materials and Methods: Retrospective cohort study of transplanted patients from July 2012 to January 2024 in a Colombian hospital. Downstaging was carried out in accordance with UNOS criteria. Death and recurrence of HCC were the primary outcomes. Cox proportional hazards model was adjusted for age and Child-Pugh score. Results and Discussion: 79 patients, 17 in downstaging group (DG) and 62 in Milan Group (MG). All patients had cirrhosis. Median age was 60 years and 71% were men. DG has less diabetes mellitus than MG (24% vs. 48%), less comorbidities (82% vs. 92%), better Child-Pugh, less ascites (6% vs. 50%), less encephalopathy (18% vs. 45%) and less variceal bleeding (17% vs. 32%). In DG, the median number of tumors was 2 (IQR: 1-3, 29% with just one) and in MG it was 1 (IQR: 1-1, 79% with just one). Dowstaging was performed using either TACE alone (88%) or in combination with radiofrequency ablation (22%). Liver specimens showed a high sum of tumor diameters in DG (4.8 cm vs. 3.0 cm), however, DG had less microvascular invasion (18% vs. 37%) and a better profile of tumor differentiation. Recurrence was 11.8% in DG and 8.2% in MG (p-value = 0.926, figure). In DG, there was a death rate of 6% while in MG it was 18% (p-value = 0.285). Conclusions: Downstaging appeared to be a successful strategy for LT that could be used to expand the Milan Criteria in Colombia. Less sick patients in DG (necessary for locoregional therapy), could have favored survival.http://www.sciencedirect.com/science/article/pii/S1665268124004617 |
| spellingShingle | Juan Ignacio Marin-Zuluaga Andres Fernando Rodriguez-Gutierrez María Fernanda Saavedra-Chacón Christian Ernesto Melgar-Burbano P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL Annals of Hepatology |
| title | P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL |
| title_full | P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL |
| title_fullStr | P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL |
| title_full_unstemmed | P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL |
| title_short | P-64 DOWNSTAGING STRATEGY FOR LIVER TRANSPLANTATION IN HEPATOCELLULAR CARCINOMA. A COHORT STUDY IN A COLOMBIAN HOSPITAL |
| title_sort | p 64 downstaging strategy for liver transplantation in hepatocellular carcinoma a cohort study in a colombian hospital |
| url | http://www.sciencedirect.com/science/article/pii/S1665268124004617 |
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