Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma

A. Cucchetti, A. Vitale, M. Del Gaudio, M. Ravaioli, G. Ercolani, M. Cescon, M. Zanello, M. C. Morelli, U. Cillo, G. L. Grazi, A. D. Pinna

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Primary transplantation offers longer life-expectancy in comparison to hepatic resection (HR) for hepatocellular carcinoma (HCC) followed by salvage transplantation; however, livers not used for primary transplantation can be reallocated to the remaining waiting-list patients, thus, the harm caused to resected patients could be balanced, or outweighed, by the benefit obtained from reallocation of livers originating from HCC patients first being resected. A Markov model was developed to investigate this issue based on literature data or estimated from the United Network for Organ Sharing database. Markov model shows that primary transplantation offers longer life-expectancy in comparison to HR and salvage transplantation if 5-year posttransplant survival remains higher than 60%. The balance between the harm for resected patients and the benefit for the remaining waiting list depends on (a) the proportion of HCC candidates, (b) the percentage shifted to HR and (c) the median expected time-to-transplant. Faced with a low proportion of HCC candidates, the harm caused to resected patients was higher than the benefit that could be obtained for the waiting-list population from re-allocation of extra livers. An increased proportion of HCC candidates and/or an increased median time-to-transplant could lead to a benefit for waiting-list patients that outweighs this harm.

Original languageEnglish
Pages (from-to)619-627
Number of pages9
JournalAmerican Journal of Transplantation
Volume10
Issue number3
DOIs
Publication statusPublished - 2010

Fingerprint

Hepatocellular Carcinoma
Waiting Lists
Transplantation
Patient Harm
Liver
Life Expectancy
Transplants
Databases
Survival
Population

Keywords

  • Hepatic resection
  • Hepatocellular carcinoma
  • Life-expectancy
  • Liver transplantation
  • Organ allocation

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Cucchetti, A., Vitale, A., Gaudio, M. D., Ravaioli, M., Ercolani, G., Cescon, M., ... Pinna, A. D. (2010). Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma. American Journal of Transplantation, 10(3), 619-627. https://doi.org/10.1111/j.1600-6143.2009.02984.x

Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma. / Cucchetti, A.; Vitale, A.; Gaudio, M. Del; Ravaioli, M.; Ercolani, G.; Cescon, M.; Zanello, M.; Morelli, M. C.; Cillo, U.; Grazi, G. L.; Pinna, A. D.

In: American Journal of Transplantation, Vol. 10, No. 3, 2010, p. 619-627.

Research output: Contribution to journalArticle

Cucchetti, A, Vitale, A, Gaudio, MD, Ravaioli, M, Ercolani, G, Cescon, M, Zanello, M, Morelli, MC, Cillo, U, Grazi, GL & Pinna, AD 2010, 'Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma', American Journal of Transplantation, vol. 10, no. 3, pp. 619-627. https://doi.org/10.1111/j.1600-6143.2009.02984.x
Cucchetti, A. ; Vitale, A. ; Gaudio, M. Del ; Ravaioli, M. ; Ercolani, G. ; Cescon, M. ; Zanello, M. ; Morelli, M. C. ; Cillo, U. ; Grazi, G. L. ; Pinna, A. D. / Harm and benefits of primary liver resection and salvage transplantation for hepatocellular carcinoma. In: American Journal of Transplantation. 2010 ; Vol. 10, No. 3. pp. 619-627.
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