Orthotopic Liver Transplantation for Hepatocellular Carcinoma: One Center's Experience in the Northeast of Brazil

Coelho, Gustavo; Vasconcelos, K.F.; Vasconcelos, J.B.M.; Barros, Marcos Aurélio Pessoa; Costa, Paulo; Borges, G.C.; Júnior, José Telmo Valença; Brasil, Ivelise Regina Canito; Filho, D.H.C.; Viana, Cyntia Ferreira Gomes; Rocha, Tarciso Daniel Santos; Mesquita, D.F.G.; Garcia, José Huygens Parente

doi:10.1016/j.transproceed.2009.01.104

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…After exclusion of duplicate publications, review articles, letters, case reports and studies reporting inappropriate outcome measures 67 relevant articles were identified for further full text review. Fifty‐four articles were subsequently excluded after full text review, due to a variety of reasons; studies with incidental tumours included, inappropriate outcome measures, simultaneous liver and kidney transplantation, inadequate sample size, follow‐up studies from the same register of recipients, inadequate or not recorded follow‐up, studies excluding patients with normal AFP levels and evidence of over‐fitting . This left 13 articles for inclusion in this review, involving 12 159 patients who underwent LT for HCC, of whom the majority were male (9603, 78.9%) with predominantly viral underlying aetiology …”

Section: Resultsmentioning

confidence: 99%

Systematic review: the prognostic role of alpha‐fetoprotein following liver transplantation for hepatocellular carcinoma

Hakeem

Young

Marangoni

et al. 2012

Aliment Pharmacol Ther

105

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Summary Background Liver transplantation (LT) offers a possible cure for carefully selected patients with hepatocellular carcinoma (HCC). Studies report that preoperative alpha‐fetoprotein (AFP) is a prognostic indicator that can predict survival and recurrence in these patients. Aim To undertake a systematic review of available literature on preoperative AFP as a predictor of survival and recurrence following LT for HCC. Methods A literature search was performed using Medline, Embase, Cochrane Library, CINAHL and Google scholar databases to identify studies reporting AFP as a prognostic marker in LT for HCC. Primary outcomes of interest were overall survival and recurrence. Secondary outcomes were correlation of pre‐LT AFP with vascular invasion and grade of tumour differentiation. Results A total of 13 studies met the inclusion criteria (12 159 patients). The majority were male (9603, 78.9%). All were observational studies and only one prospective. Methodological quality was rated as poor for all studies, with selection and observer bias apparent for most cohorts. Reported survival rates and recurrence rates varied widely between the studies although overall demonstrated better outcomes for those with lower (<1000 ng/mL) pre‐LT AFP levels. Similarly, rates of vascular invasion and poor tumour differentiation were higher in those with high pre‐LT AFP levels. Conclusions A quantity of AFP >1000 ng/mL is associated with poorer outcomes from liver transplantation for hepatocellular carcinoma. The quality of studies was generally poor and precluded valid statistical meta‐analysis. There is a need to improve the performance and reporting of primary prognostic studies to facilitate high quality systematic review and meta‐analysis.

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Section: Resultsmentioning

confidence: 99%

Systematic review: the prognostic role of alpha‐fetoprotein following liver transplantation for hepatocellular carcinoma

Hakeem

Young

Marangoni

et al. 2012

Aliment Pharmacol Ther

105

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“…The relationship between MVI and LT outcomes is still a matter of debate. The majority of studies favor the view of a relationship between MVI and poor posttransplant outcomes 1‐11, 35‐53. Many studies have reported a close correlation between the presence of MVI and a poor prognosis after LT; Bhattacharjya et al6 performed a prospective study of 30 patients treated with LT for relatively small HCCs (range = 6‐75 mm).…”

Section: Resultsmentioning

confidence: 99%

Markers for microvascular invasion in hepatocellular carcinoma: Where do we stand?

Gouw

Balabaud²,

Kusano

et al. 2011

Liver Transpl

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It is well known that hepatocellular carcinoma (HCC) commonly involves the local branches of portal and/or hepatic veins and causes a tumor thrombus even at a relatively early stage. Vascular invasion is classified as macrovascular invasion, which is grossly recognizable (mostly in large to medium vessels), or microvascular invasion (MVI), which can be identified only by microscopic observation (mainly in small vessels such as portal vein branches in portal tracts, central veins in noncancerous liver tissue, and venous vessels in the tumor capsule and/or noncapsular fibrous septa).Although macroscopic vascular invasion in major vessels (and satellite nodules) is known to be a marker of poor outcomes after liver transplantation (LT) for HCC and is regarded as a contraindication for LT, the significance of MVI as a predictor of poor outcomes is still controversial. The controversy concerns the extent to which MVI (if it is identifiable before surgery) is a contraindication for LT, even though we know that only a minority of patients with MVI will experience HCC recurrence. MATERIALS AND METHODSWe searched the MEDLINE database (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) to determine the significance of MVI to the outcomes of LT for HCC; we used the keywords hepatocellular carcinoma, HCC, microvascular invasion, liver transplantation, and liver resection. We also performed a full manual search of the bibliographies of selected publications and included 4 additional publications from earlier years. Publications were included if they contained data on MVI and its relationship with tumor characteristics and/or prognostic data. The search resulted in a total of 48 relevant publications.The publications were then ranked according to the classification proposed by the Oxford Centre for Evidenced-Based Medicine.

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“…In 2006, the Brazilian government adopted the MELD score to determine the priority for performing liver transplantation (11) . The severity scores of MELD and Child did not differ between transplanted patients with HBV and HDV demonstrating that the groups had similar levels of impaired liver function.…”

Section: Discussionmentioning

confidence: 99%

Liver Transplantation in Hepatitis Delta: South America Experience

Lima

Júnior

Barreira

et al. 2018

Arq. Gastroenterol.

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The hepatitis by delta virus patients who underwent liver transplantation were predominantly male, coming from the Brazilian Amazon region and with similar liver function to the hepatitis B virus patients. They had a lower incidence of hepatocellular carcinoma, more marked perioperative thrombocytopenia levels and frequent episodes of upper gastrointestinal bleeding. Patients with hepatitis by delta virus had lower mortality and higher survival than patients with hepatitis B virus.

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Orthotopic Liver Transplantation for Hepatocellular Carcinoma: One Center's Experience in the Northeast of Brazil

Cited by 12 publications

References 18 publications

Systematic review: the prognostic role of alpha‐fetoprotein following liver transplantation for hepatocellular carcinoma

Systematic review: the prognostic role of alpha‐fetoprotein following liver transplantation for hepatocellular carcinoma

Markers for microvascular invasion in hepatocellular carcinoma: Where do we stand?

Liver Transplantation in Hepatitis Delta: South America Experience

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