Liver Transplantation in Brazil: The Urgent Need of a New Allocation System for the Exceptions in Meld Score

Andraus, Wellington

doi:10.1590/s0004-2803.202000000-01

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…This system grants exception points for specific criteria in HCC cases. However, it does not permit the inclusion of patients with other primary malignant liver neoplasms, thereby limiting the chances for individuals with iCC to be added to the waiting list ( 27 ).…”

Section: Ldlt For Iccmentioning

confidence: 99%

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

Andraus,

Ochoa,

de Martino

et al. 2024

Front. Oncol.

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IntroductionIntrahepatic cholangiocarcinoma (iCC) is the liver’s second most common neoplasm. Until now, surgery is the only curative option, but only 35% of the cases are considered resectable at the diagnosis, with a post-resection survival of around 30%. Advancements in surgical techniques and perioperative care related to liver transplantation (LT) have facilitated the expansion of indications for hepatic neoplasms.MethodThis study is a comprehensive review of the global experience in living donor LT (LDLT) for treating iCC and describes our first case of LDLT for an unresectable iCC.ResultsWhile exploring LT for intrahepatic cholangiocarcinoma dates to the 1990s, the initial outcomes were discouraging, marked by poor survival and high recurrence rates. Nevertheless, contemporary perspectives underscore a reinvigorated emphasis on extending the frontiers of LT indications within the context of the “oncologic era.” The insights gleaned from examining explants, wherein incidental iCC was categorized as hepatocellular carcinoma in the preoperative period, have demonstrated comparable survival rates to small hepatocellular carcinoma. These findings substantiate the potential viability of LT as a curative alternative for iCC. Another investigated scenario pertains to “unresectable tumors with favorable biological behavior,” LT presents a theoretical advantage by providing free margins without the concern of a small future liver remnant. The constraint of organ shortage persists, particularly in nations with low donation rates. LDLT emerges as a viable and secure alternative for treating iCC.ConclusionLDLT is an excellent option for augmenting the graft pool, particularly in carefully selected patients.

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Section: Ldlt For Iccmentioning

confidence: 99%

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

Andraus,

Ochoa,

de Martino

et al. 2024

Front. Oncol.

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Survival benefit of living-donor liver transplantation in patients with a model for end-stage liver disease over 30 in a region with severe organ shortage: a retrospective cohort study

Yim

Kim

Kang

et al. 2023

International Journal of Surgery

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Background: The benefits of living-donor liver transplantation (LDLT) in patients with a high Model for End-stage Liver Disease (MELD) score (who have high waitlist mortality) are unclear. Regional availability of deceased-donor organs must be considered when evaluating LDLT benefits. We aimed to compare the survival benefit of intended-LDLT to awaiting deceased-donor liver transplantation (DDLT) in patients with a MELD score ≥30 in a region with severe organ shortage. Materials and Methods: This retrospective review included 649 patients with a MELD score ≥30 placed on the liver transplantation waitlist. They were divided into Intended-LDLT (n=205) or Waiting-DDLT (n=444) groups based on living-donor eligibility and compared for patient survival from time of waitlisting. Post-transplantation outcomes of transplant recipients and living donors were analyzed. Results: Intended-LDLT patients had higher 1-year survival than Waiting-DDLT patients (53.7% vs. 28.8%, P<0.001). LDLT was independently associated with lower mortality (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.48–0.79; P<0.001). During follow-up, 25 patients were de-listed, 120 underwent LDLT, 170 underwent DDLT, and 334 remained on the waitlist. Among patients undergoing transplantation, the risk of post-transplantation mortality was similar for LDLT and DDLT after adjusting for pre-transplantation MELD score (HR, 1.86; 95% CI, 0.73–4.75; P=0.193), despite increased surgical complications after LDLT (33.1% vs. 19.4%, P=0.013). There was no mortality among living-donors, but 4.2% experienced complications of grade 3 or higher. Conclusions: Compared to awaiting DDLT, LDLT offers survival benefits for patients with a MELD score ≥30, while maintaining acceptable donor outcomes. LDLT is a feasible treatment for patients with a MELD score ≥30 in regions with severe organ shortage.

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Liver Transplantation in Brazil: The Urgent Need of a New Allocation System for the Exceptions in Meld Score

Cited by 2 publications

References 6 publications

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

Survival benefit of living-donor liver transplantation in patients with a model for end-stage liver disease over 30 in a region with severe organ shortage: a retrospective cohort study

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