Prognostic role of selection criteria for liver transplantation in patients with hepatocellular carcinoma: a network meta-analysis

Abstract

Background Patients with hepatocellular carcinoma (HCC) are selected for transplantation if they have a low tumour burden and low risk of recurrence. The morphometric Milan criteria have been the cornerstone for patient selection, but dynamic morphological and biological tumour characteristics surfaced as an encouraging tool to refine the selection of patients with HCC and to support the expansion of the Milan criteria. The outcomes of the most prevalent models that select patients with HCC for liver transplantation were analysed in this study, which aimed to identify the selection model that offered the best recurrence-free and overall survival after transplantation. Methods Studies that compared Milan, University of California San Francisco (UCSF), up-to-seven (UPTS), alpha-fetoprotein (AFP), and MetroTicket 2.0 (MT2) models were included. One-year, 3-year, and 5-year recurrence-free and overall survival rates of patients selected for transplantation using different models were analysed. Results A total of 60 850 adult patients with HCC selected for liver transplantation using Milan, UCSF, UPTS, AFP, or MT2 criteria were included. Patients selected for transplantation using the MT2 model had the highest 1-, 3-, and 5-year recurrence-free survival. In addition, patients selected for transplantation using MT2 criteria had the best 1- and 3-year overall survival, whereas patients selected for transplantation using the Milan criteria had the best 5-year overall survival rates. Conclusion The MT2 model offered the best post-transplant outcomes in patients with HCC, highlighting the importance of considering tumour morphology and biology when selecting patients with HCC for liver transplantation.

Living-Donor Liver Transplantation for a Large Hepatocellular Carcinoma in a Genetically Identical Twin Sister

“…There have been efforts to extend the Milan criteria as other treatment options are lacking and the survival rates of patients transplanted outside the Milan criteria are considerable 15 16 17 18 .…”

“…However, due to organ shortages, DDLT is still reserved for patients with the most favorable postoperative outcome, which is widely accepted to be HCCs inside the Milan criteria 18 . In our patient, the impressive size of the HCC (18 cm diameter) has excluded her from any established transplantation criteria for DDLT.…”

“…There have been efforts to extend the Milan criteria as other treatment options are lacking and the survival rates of patients transplanted outside the Milan criteria are considerable [15,16,17,18]. The University of California, San Francisco (UCLF)'s classification can be considered a wider classification.…”

Pushing the limits of treatment for hepatocellular carcinoma

“…Many selection criteria models have attempted to estimate outcomes based on pre-LT tumor size, number, and biomarker thresholds [12–15]. A recently published meta-analysis compared post-LT outcomes between the Milan, UCSF, Up-to-Seven (UPTS), French AFP (FAFP), and MetroTicket 2.0 (MT2) models [16 ▪▪ ]. They found that the MT2 model (which incorporates tumor number and size as well as AFP level) had the highest 1-, 3-, and 5-year DFS, and within MC patients had the highest 5-year overall survival rates.…”