Efetividade do protocolo de seguimento dos pacientes portadores de carcinoma hepatocelular submetidos a transplante de fígado no Estado de São Paulo
Data
2024-08-28
Autores
Takenaka, Vanessa Suemi 
Orientadores
Gonzales, Adriano Miziara
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar o percentual de falha na identificação de pacientes portadores de carcinoma hepatocelular (CHC) submetidos à transplante hepático (TxH) fora dos critérios válidos no Brasil - Critérios de Milão/Brasil (CMB) no momento do transplante, avaliar as variáveis clínico-epidemiológicas e sobrevida global destes pacientes. Métodos: Foram coletadas informações do banco de dados da Central de Transplantes do Estado de São Paulo, de pacientes submetidos à TxH com doador falecido em situação especial por CHC, no período entre janeiro de 2012 a janeiro de 2022. Classificados em dois grupos: Dentro do CMB e fora do CMB, baseado no estadiamento anatomopatológico dos fígados explantados. Resultados: Dos 1115 pacientes transplantados em São Paulo nesse período por CHC, 988 (88,6%) estavam dentro dos CMB no momento do TxH e 127 (11,4%) foram transplantados fora dos CMB. Comparando os grupos os pacientes que foram inscritos após downstaging (11,6% dentro CMB e 25,2% fora CMB -p<0,001), estadiamento na inscrição como CMB (dentro CMB 16,9% e fora CMB 21,3%; p = 0,015), estadiamento no exame de imagem pré-TxH (dentro CMB 22,8% e fora CMB 44,1% ; p <0,001), e maior nível de AFP no exame de inscrição analisando o log AFP (p=0,004) e AFP pré-transplante (dentro CMB de 74,63 ng/mL e fora CMB de 252,27 ng/mL – p=003), foram os que tiveram maior chance de serem transplantados além do CMB. A sobrevida em 5 anos dos pacientes dentro dos CMB foi de 68% e dos pacientes que estavam fora dos CMB de 46%, com diferença estatisticamente significativa (p< 0,0001). Conclusões: O protocolo de seguimento para assegurar que os pacientes portadores de CHC sejam submetidos a transplante de fígado dentro dos critérios estabelecidos falha em 11,4%, com pior sobrevida nesse grupo. Os pacientes com maior risco de serem transplantados além dos critérios são: submetidos à downstaging, estadiamento mais avançado na inscrição e no pré-TxH, e maior nível de AFP no exame de inscrição e pré-TxH.
Objective: To evaluate the failure rate in identifying hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) outside the Milan/Brazil Criteria (CMB) at the time of transplantation, as well as the clinical-epidemiological variables and overall survival of these patients. Methods: Data were collected from the Transplant Center of the State of São Paulo database for patients undergoing LT with a deceased donor due to HCC between January 2012 and January 2022. A total of 1,115 patients were analyzed and classified into two groups: within CMB and outside CMB, based on the pathology of the explanted livers. Results: Of the 1,115 patients transplanted in São Paulo during this period due to HCC, 988 (88.6%) were within the CMB at the time of LT, while 127 (11.4%) underwent LT outside the CMB. Comparing the groups, patients who had undergone downstaging showed 11.6% within CMB and 25.2% outside CMB (p < 0.001). Staging at enrollment showed 16.9% within CMB and 21.3% outside CMB (p = 0.015), and pre-LT imaging exam staging showed 22.8% within CMB and 44.1% outside CMB (p < 0.001). Additionally, higher AFP levels at enrollment examination analyzing log AFP (p=0.004) and pre-transplant AFP (inside CMB of 74.63 ng/mL and outside CMB of 252.27 ng/mL – p=003), were associated with a higher likelihood of transplantation beyond the CMB. The 5-year survival rate for patients within the CMB was 68%, compared to 46% for those outside the CMB, with a statistically significant difference (p < 0.0001). Conclusions: The protocol for ensuring that HCC patients undergo liver transplantation within the established criteria fails in 11.4% of cases, resulting in worse survival for this group. Patients at higher risk of being transplanted beyond the criteria were those who had undergone downstaging, had more advanced staging at enrollment and pre-LT, and had higher AFP levels at enrollment and pre-LT.
Objective: To evaluate the failure rate in identifying hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) outside the Milan/Brazil Criteria (CMB) at the time of transplantation, as well as the clinical-epidemiological variables and overall survival of these patients. Methods: Data were collected from the Transplant Center of the State of São Paulo database for patients undergoing LT with a deceased donor due to HCC between January 2012 and January 2022. A total of 1,115 patients were analyzed and classified into two groups: within CMB and outside CMB, based on the pathology of the explanted livers. Results: Of the 1,115 patients transplanted in São Paulo during this period due to HCC, 988 (88.6%) were within the CMB at the time of LT, while 127 (11.4%) underwent LT outside the CMB. Comparing the groups, patients who had undergone downstaging showed 11.6% within CMB and 25.2% outside CMB (p < 0.001). Staging at enrollment showed 16.9% within CMB and 21.3% outside CMB (p = 0.015), and pre-LT imaging exam staging showed 22.8% within CMB and 44.1% outside CMB (p < 0.001). Additionally, higher AFP levels at enrollment examination analyzing log AFP (p=0.004) and pre-transplant AFP (inside CMB of 74.63 ng/mL and outside CMB of 252.27 ng/mL – p=003), were associated with a higher likelihood of transplantation beyond the CMB. The 5-year survival rate for patients within the CMB was 68%, compared to 46% for those outside the CMB, with a statistically significant difference (p < 0.0001). Conclusions: The protocol for ensuring that HCC patients undergo liver transplantation within the established criteria fails in 11.4% of cases, resulting in worse survival for this group. Patients at higher risk of being transplanted beyond the criteria were those who had undergone downstaging, had more advanced staging at enrollment and pre-LT, and had higher AFP levels at enrollment and pre-LT.