Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

Krawczyk, Marek; Grąt, Michał; Grąt, Karolina; Wronka, Karolina Maria; Krasnodębski, Maciej; Stypułkowski, Jan; Masior, Łukasz; Hołówko, Wacław; Ligocka, Joanna; Nyckowski, P; Wróblewski, Tadeusz; Paluszkiewicz, Rafał; Patkowski, Waldemar; Zieniewicz, Krzysztof; Pączek, Leszek; Milkiewicz, Piotr; Ołdakowska‐Jedynak, Urszula; Najnigier, B; Dudek, Krzysztof; Remiszewski, Piotr; Grzelak, I; Kornasiewicz, Oskar; Kotulski, Marcin; Smoter, Piotr; Grodzicki, Mariusz; Korba, Michał; Kalinowski, Piotr; Skalski, Michał; Zając, Krzysztof; Stankiewicz, Rafał; Przybysz, Marta; Cieślak, Bartosz; Nazarewski, Łukasz; Nowosad, Małgorzata; Kobryń, Konrad; Wasilewicz, Michał; Raszeja‐Wyszomirska, Joanna; Piwowarska, Jadwiga; Giercuszkiewicz, Dorota; Sańko-Resmer, Joanna; Rejowski, Sławomir; Szydłowska-Jakimiuk, Monika; Górnicka, Barbara; Wróblewska-Ziarkiewicz, Bogna; Mazurkiewicz, Michał; Niewiński, Grzegorz; Pawlak, Jacek; Pacho, Ryszard

doi:10.1515/pjs-2015-0046

Cited by 8 publications

(7 citation statements)

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“…The discrepancy between the >50% 5-year survival observed for high-risk HCC patients in the present study and the 20% historical rate is potentially related to an overall improvement of transplantation results, an argument currently raised in the discussion on reinitiation of transplantation for unresectable colorectal cancer metastases. 21 , 24 , 27 – 29 …”

Section: Discussionmentioning

confidence: 99%

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Challenging the principle of utility as a barrier for wider use of liver transplantation for hepatocellular cancer

et al. 2017

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Background. Although transplant benefit appears superior for patients with advanced hepatocellular cancer (HCC), liver transplantation remains limited to selected low-risk HCC patients to keep their outcomes similar to heterogeneous group of non-HCC patients. The purpose of this study was to assess the rationale for current policy of restricting access to liver transplantation to minority of HCC patients based on utility principle. Methods. This retrospective cohort study comprised 1246 liver transplant recipients, including 206 HCC and 1040 non-HCC patients. Patient survival was the primary outcome measure. Patients with HCC and benign diseases were divided into low-, moderate-, and high-risk subgroups basing on independent risk factors for disease-free survival and model for end-stage liver disease (MELD) score (\30, 30-40, [40), respectively. Results. MELD (p \ 0.001) and presence of HCC (p = 0.008) were independent risk factors for early and late mortality, respectively. Total tumor volume (p = 0.008) and alpha-fetoprotein (p = 0.013) were independent predictors of recurrence and mortality used for division of HCC patients into low-, moderate-, and highrisk subgroups, with disease-free survival rates of 74.9% (5 years), 51.7% (5 years), and 8.0% (3 years), respectively (p \ 0.001). There were no differences in 5-year overall survival between low-risk HCC (74.9%) and non-HCC (81.9%) patients (p = 0.210), moderate-risk HCC (63.3%) and non-HCC (68.0%) patients (p = 0.372), and high-risk HCC (55.0%) and non-HCC (56.0%) patients (p = 0.559). Conclusions. The principle of utility is unequally applied for restriction of access to liver transplantation for HCC patients. The results provide rationale for discussion on reinitiation of liver transplantation for advanced HCCs.

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Section: Discussionmentioning

confidence: 99%

“…Information on the operative technique, immunosuppression protocol, and posttransplant follow-up was provided previously. 19 – 21 …”

Section: Methodsmentioning

confidence: 99%

Challenging the principle of utility as a barrier for wider use of liver transplantation for hepatocellular cancer

et al. 2017

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“…The secondary endpoint was patient death at 5 years (irrespective of the cause), which was used to calculate overall survival (OS, secondary outcome measure). Details on the center’s experience, perioperative management, operative technique, immunosuppression protocol, and long-term follow-up were provided elsewhere 34,35…”

Section: Methodsmentioning

confidence: 99%

The Warsaw Proposal for the Use of Extended Selection Criteria in Liver Transplantation for Hepatocellular Cancer

et al. 2016

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BackgroundCombination of the University of California, San Francisco (UCSF) and the up-to-7 criteria with alpha-fetoprotein (AFP) cutoff of 100 ng/ml was proposed as the Warsaw expansion of the Milan criteria in selection of hepatocellular cancer (HCC) patients for liver transplantation. The purpose of this retrospective study was to validate this proposal.MethodsA total of 240 HCC patients after liver transplantation were included. Recurrence-free survival and overall survival at 5 years were set as the primary and secondary outcome measures, respectively.ResultsThe Warsaw expansion increased transplant eligibility rate by 20.3 %. AFP >100 ng/ml significantly increased the recurrence risk in patients within the Milan criteria (p = 0.025) and in those beyond, yet within either the UCSF or the up-to-7 criteria (p < 0.001). Recurrence-free survival at 5 years was 90.8 % for patients within the Milan criteria, 100.0 % in patients within the Warsaw expansion, 54.9 % in patients beyond the Warsaw expansion but within either the UCSF or the up-to-7 criteria, and 45.1 % in patients beyond both the UCSF and the up-to-7 criteria (p < 0.001). The corresponding overall survival rates were 71.6, 82.4, 64.3, and 55.3 %, respectively (p = 0.027).ConclusionsThe Warsaw expansion of the Milan criteria substantially increases the recipient pool without compromising outcomes.

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“…Although the slight difference between the survival outcomes presented here and those previously reported may be related to the number of evaluated patients, several other potential reasons exist. First, the overall LT results improved over the last 2 decades . Second and potentially more important, possible explanations of differences in long‐term survival are related to the patient selection policy used in our center.…”

Section: Discussionmentioning

confidence: 99%

Alveococcosis of the liver – strategy of surgical treatment with special focus on liver transplantation

Patkowski

Kotulski

Remiszewski

et al. 2016

Transplant Infectious Dis

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Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw

Cited by 8 publications

References 28 publications

Challenging the principle of utility as a barrier for wider use of liver transplantation for hepatocellular cancer

Challenging the principle of utility as a barrier for wider use of liver transplantation for hepatocellular cancer

The Warsaw Proposal for the Use of Extended Selection Criteria in Liver Transplantation for Hepatocellular Cancer

Alveococcosis of the liver – strategy of surgical treatment with special focus on liver transplantation

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