TY - JOUR
T1 - Liver allocation for hepatocellular carcinoma
T2 - A European center policy in the pre-MELD era
AU - Ravaioli, Matteo
AU - Grazi, Gian Luca
AU - Ercolani, Giorgio
AU - Cescon, Matteo
AU - Del Gaudio, Massimo
AU - Zanello, Matteo
AU - Ballardini, Giorgio
AU - Varotti, Giovanni
AU - Vetrone, Gaetano
AU - Tuci, Francesco
AU - Lauro, Augusta
AU - Ramacciato, Giovanni
AU - Pinna, Antonio Daniele
PY - 2006/2
Y1 - 2006/2
N2 - Background. Policies to decrease dropout during waiting time for liver transplantation (LT) are under debate. Methods. We evaluated the allocation system from 1996 to 2003, when recipients had priority related to Child-Pugh score and donors >60 years were mainly offered to recipients with hepatocellular carcinoma (HCC). The outcomes of 656 patients with chronic liver disease (142 HCC and 514 non-HCC) listed for LT were prospectively evaluated, considering recipient and donor features. Results. Transplantation and dropout rates were similar between HCC and non-HCC patients: 64.1% vs. 70.6% and 26% vs. 22.6%. Multivariate analysis showed the probability of being transplanted within 3 months was related to Child-Pugh score >10 and to HCC, whereas the probability of being removed from the list within 3 months was only related to Child-Pugh score >10. HCC patients had a lower median waiting time (97 vs. 197 days, P 60 years (50.5% vs. 33.5%, P 60 years affected outcome after LT in the non-HCC group, but not in the HCC patients. Conclusion. By allocating donors >60 years mainly to HCC patients, we controlled dropout without affecting their survival and the outcome of non-HCC patients.
AB - Background. Policies to decrease dropout during waiting time for liver transplantation (LT) are under debate. Methods. We evaluated the allocation system from 1996 to 2003, when recipients had priority related to Child-Pugh score and donors >60 years were mainly offered to recipients with hepatocellular carcinoma (HCC). The outcomes of 656 patients with chronic liver disease (142 HCC and 514 non-HCC) listed for LT were prospectively evaluated, considering recipient and donor features. Results. Transplantation and dropout rates were similar between HCC and non-HCC patients: 64.1% vs. 70.6% and 26% vs. 22.6%. Multivariate analysis showed the probability of being transplanted within 3 months was related to Child-Pugh score >10 and to HCC, whereas the probability of being removed from the list within 3 months was only related to Child-Pugh score >10. HCC patients had a lower median waiting time (97 vs. 197 days, P 60 years (50.5% vs. 33.5%, P 60 years affected outcome after LT in the non-HCC group, but not in the HCC patients. Conclusion. By allocating donors >60 years mainly to HCC patients, we controlled dropout without affecting their survival and the outcome of non-HCC patients.
KW - Dropout
KW - Hepatocellular carcinoma
KW - Intention-to-treat
KW - Liver allocation
KW - Liver transplantation
KW - Marginal graft
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U2 - 10.1097/01.tp.0000198741.39637.44
DO - 10.1097/01.tp.0000198741.39637.44
M3 - Article
C2 - 16495798
AN - SCOPUS:33644626241
VL - 81
SP - 525
EP - 530
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 4
ER -