Transplante de fígado de acordo com os critérios de Milão: revisão dos últimos 10 anos

Abstract

RESUMO:Introdução: O transplante de fígado (TF) continua sendo o melhor tratamento para pacientes, bem selecionados, portadores de carcinoma hepatocelular. Os critérios de Milão (CM) ( tumor único até 5 cm e 3 tumores não maiores que 3 cms) são os critérios mais usados para estes pacientes. Nosso objetivo é avaliar a situação atual dos CM principalmente a sobrevida do paciente e a taxa livre de recorrência tumoral após 1 a 5 anos do TF, nos últimos 10 anos. Material e Métodos: Revisamos 59 trabalhos entre 200-2009; da Asia (42,3%), Europa (33,9%) e da América do Norte (20,4%). 5.525 pacientes submeteram-se ao TF com os CM. A sobrevida total dos pacientes e a taxa livre de recorrência tumoral foram analisados. Resultados: A taxa de sobrevida total dos pacientes foi em 1 ano de (87,26%), 2 anos (81,95%), 3 anos (77,47%), 4 anos (75,24%) e 5 anos (72,41%). A taxa livre de recorrência tumoral foi de 80,29% e 71,36% em 1 e 5 anos, respectivamente. Conclusão: A melhor taxa de sobrevida dos pacientes foi na América do Norte (88%) e na Asia (76,6%), respectivamente. Por outro lado, a Europa teve a melhor taxa livre de recorrência de doença em 5 anos (91,8%). DEScRitORES:Transplante de fígado/normas; Carcinoma hepatocelular/terapia; Seguimentos. remains an excellent treatment approach for HCC in well-selected candidates. Milan Criteria (MC) (a single tumor up to 5cm or up to 3 tumors none larger than 3.0 cm) is the most widely used criteria for selection of those patients. Our aim is to study the current situation of the MC focusing on patient survival and tumor recurrence free rate from 1 to 5-yrs after OLT over the past 10 years. Material and Methods: We have reviewed 59 papers published between 2000-2009; from Asia (42.3%), Europe (33.9%) and North America (20.4%). 5.525 patients have undergone OLT within MC. The overall patient survival rate and tumor recurrence free rate from 1 to 5-yrs were analyzed. Results: Overall patient survival rates were 1 year (87.26%), 2 years (81.95%), 3 years (77.47%), 4 years (75.24%) and 5 years (72.41%). We have found tumor recurrence free rate of 80.29% and 71.36% at 1 and 5-yrs, respectively. Conclusion: MC has come to simplify the indication for LT in patients with HCC. The best patient survival rate at 1 and 5 years were in North America (88%) and Asia (76,6%), respectively. On the other hand, Europe had the best tumor recurrence free rate at 5 years (91.8%). Rev Med (São Paulo

Liver transplantation in a patient with hepatitis B, C and D coinfection associated with hepatocellular carcinoma: a management strategy for a rare condition. Case report

“…These findings led to a preliminary diagnosis of suspected HCC of viral etiology caused by HBV and HDV coinfection, which is an indication for liver transplantation based on the modified Milan criteria used in Brazil. [4][5][6] The patient's model for end-stage liver disease (MELD) score was 14, and he was put on the liver transplantation waiting list.…”

Acoustic radiation force impulse (ARFI) elastography compared with biopsy for evaluating hepatic fibrosis after liver transplantation: a cross-sectional diagnostic study

“…[1][2][3][4] Nonetheless, histological changes in transplanted livers can occur subclinically and progressively even in asymptomatic patients and without significant laboratory alterations. [3][4][5][6] Liver biopsy is currently the gold standard for histological evaluation of the liver.…”

“…[1][2][3][4] Nonetheless, histological changes in transplanted livers can occur subclinically and progressively even in asymptomatic patients and without significant laboratory alterations. [3][4][5][6] Liver biopsy is currently the gold standard for histological evaluation of the liver. [7][8][9][10] However, it is invasive and poses a risk of complications with morbidity around 0.3 to 0.6% and mortality of 0.05%, besides hospitalization of at least 6-18 hours.…”

“…[7][8][9][10] However, it is invasive and poses a risk of complications with morbidity around 0.3 to 0.6% and mortality of 0.05%, besides hospitalization of at least 6-18 hours. 3,4 In order to diagnose these alterations, some transplantation centers recommend routine biopsies at fixed intervals (annually) after liver transplantation, thus called "protocol biopsies".…”

“…3,4 The main histological alterations observed in anatomopathological evaluations on biopsies on transplanted livers involve inflammation and fibrosis. 6 However, the degree of fibrosis may be underestimated in situations of inadequate sampling, given that the volume of the sample evaluated in the biopsy is only 1/50,000 of the organ.…”