Liver Transplantation For Carcinoma Hepatocellular In Sao Paulo: 414 Cases By The Milan/Brazil Criteria

Liver Transplantation For Carcinoma Hepatocellular In Sao Paulo: 414 Cases By The Milan/Brazil Criteria

Alternative title O Transplante Hepático Por Hepatocarcinoma Na Era Meld Em São Paulo: Análise De 414 Casos Transplantados Pelo Critério De Milão/Brasil
Author Sá, Gustavo Pilotto Domingues Autor UNIFESP Google Scholar
Vicentine, Fernando Pompeu Piza Autor UNIFESP Google Scholar
Salzedas-Netto, Alcides Augusto Autor UNIFESP Google Scholar
Matos, Carla Adriana Loureiro de Autor UNIFESP Google Scholar
Romero, Luis Ramiro Núñez Autor UNIFESP Google Scholar
Tejada, Dario Fernandes Perdomo Autor UNIFESP Google Scholar
Bosco Massarollo, Paulo Celso Google Scholar
Lopes Filho, Gaspar de Jesus Autor UNIFESP Google Scholar
Gonzalez, Adriano Miziara Autor UNIFESP Google Scholar
Abstract Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules. Aim: To evaluate the outcome of liver transplantation within the CMB. Methods: The medical records of patients with HCC undergoing liver transplantation in relation to recurrence and survival by comparing CM and CMB, were analyzed. Results: 414 LTx for HCC, the survival at 1 and 5 years was 84.1 and 72.7%. Of these, 7% reached the CMB through downstaging, with survival at 1 and 5 years of 93.1 and 71.9%. The CMB patient group that exceeded the CM (8.6%) had a survival rate of 58.1% at five years. There was no statistical difference in survival between the groups CM, CMB and downstaging. Vascular invasion (p<0.001), higher nodule size (p=0.001) and number of nodules >2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p<0.001), real MELD (p<0.001), vascular invasion (p=0.045) and number of nodes >2 cm (p<0.014) were associated with worse survival. Conclusions: CMB increased by 8.6% indications of liver transplantation, and showed survival rates similar to CM.

Racional: O critério de Milão (CM) vem sendo utilizado como padrão para indicação do transplante hepático (TxH) por hepatocarcinoma (HCC) em todo mundo há quase 20 anos. Diversos centros têm adotado critérios expandidos com intuito de aumentar o número de pacientes candidatos ao transplante, mantendo bons índices de sobrevida. No Brasil, desde 2006, o critério de Milão/Brasil (CMB), que desconsidera nódulos <2 cm, é adotado, incluindo pacientes com maior número de nódulos pequenos. Objetivo: Avaliar o resultado do transplante hepático dentro do CMB. Métodos: Foram analisados os prontuários dos pacientes com HCC submetidos ao TxH em relação à recidiva e sobrevida através da comparação entre CM e CMB. Resultados: Em 414 TxH por HCC, a sobrevida em 1 e 5 anos foi de 84,1 e 72,7%. Destes, 7% atingiram o CMB através de downstaging, com sobrevida em 1 e 5 anos de 93,1 e 71,9%. O grupo de pacientes do CMB que excederam o CM (8,6%) teve sobrevida de 58,1% em cinco anos. Não houve diferença estatística na sobrevida entre os grupos CM, CMB e downstaging. A invasão vascular (p<0,001), tamanho do maior nódulo (p=0,001) e número de nódulos >2 cm (p=0,028) associaram-se com recidiva. A idade (p=0,001), sexo feminino (p<0,001), MELD real (p<0,001), invasão vascular (p=0,045) e o número de nódulos >2 cm (p<0,014) estiveram associados com a piora na sobrevida. Conclusões: O CMB aumentou em 8,6% as indicações de TxH e apresentou índices de sobrevida semelhantes ao CM.
Keywords Liver transplantation
Hepatocellular carcinoma
MELD
Transplante hepático
Hepatocarcinoma
MELD
xmlui.dri2xhtml.METS-1.0.item-coverage Sao Paulo Sp
Language Portuguese
English
Date 2016
Published in Abcd-Arquivos Brasileiros De Cirurgia Digestiva-Brazilian Archives Of Digestive Surgery. Sao Paulo Sp, v. 29, n. 4, p. 240-245, 2016.
ISSN 0102-6720 (Sherpa/Romeo, impact factor)
Publisher Colegio Brasileiro Cirurgia Digestiva-Cbcd
Extent 240-245
Origin http://dx.doi.org/10.1590/0102-6720201600040007
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000392703900007
SciELO ID S0102-67202016000400240 (statistics in SciELO)
URI https://repositorio.unifesp.br/handle/11600/56941

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