Challenging the principle of utility as a barrier for wider use of liver transplantation for hepatocellular cancer View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-07-10

AUTHORS

Michał Grąt, Jan Stypułkowski, Waldemar Patkowski, Karolina M. Wronka, Emil Bik, Maciej Krasnodębski, Łukasz Masior, Zbigniew Lewandowski, Michał Wasilewicz, Karolina Grąt, Marek Krawczyk, Krzysztof Zieniewicz

ABSTRACT

BACKGROUND: Although transplant benefit appears superior for patients with advanced hepatocellular cancer (HCC), liver transplantation remains limited to selected low-risk HCC patients to keep their outcomes similar to heterogeneous group of non-HCC patients. The purpose of this study was to assess the rationale for current policy of restricting access to liver transplantation to minority of HCC patients based on utility principle. METHODS: This retrospective cohort study comprised 1246 liver transplant recipients, including 206 HCC and 1040 non-HCC patients. Patient survival was the primary outcome measure. Patients with HCC and benign diseases were divided into low-, moderate-, and high-risk subgroups basing on independent risk factors for disease-free survival and model for end-stage liver disease (MELD) score (<30, 30-40, >40), respectively. RESULTS: MELD (p < 0.001) and presence of HCC (p = 0.008) were independent risk factors for early and late mortality, respectively. Total tumor volume (p = 0.008) and alpha-fetoprotein (p = 0.013) were independent predictors of recurrence and mortality used for division of HCC patients into low-, moderate-, and high-risk subgroups, with disease-free survival rates of 74.9% (5 years), 51.7% (5 years), and 8.0% (3 years), respectively (p < 0.001). There were no differences in 5-year overall survival between low-risk HCC (74.9%) and non-HCC (81.9%) patients (p = 0.210), moderate-risk HCC (63.3%) and non-HCC (68.0%) patients (p = 0.372), and high-risk HCC (55.0%) and non-HCC (56.0%) patients (p = 0.559). CONCLUSIONS: The principle of utility is unequally applied for restriction of access to liver transplantation for HCC patients. The results provide rationale for discussion on reinitiation of liver transplantation for advanced HCCs. More... »

PAGES

3188-3195

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-017-5989-x

DOI

http://dx.doi.org/10.1245/s10434-017-5989-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1090594253

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28695391


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    "description": "BACKGROUND: Although transplant benefit appears superior for patients with advanced hepatocellular cancer (HCC), liver transplantation remains limited to selected low-risk HCC patients to keep their outcomes similar to heterogeneous group of non-HCC patients. The purpose of this study was to assess the rationale for current policy of restricting access to liver transplantation to minority of HCC patients based on utility principle.\nMETHODS: This retrospective cohort study comprised 1246 liver transplant recipients, including 206 HCC and 1040 non-HCC patients. Patient survival was the primary outcome measure. Patients with HCC and benign diseases were divided into low-, moderate-, and high-risk subgroups basing on independent risk factors for disease-free survival and model for end-stage liver disease (MELD) score (<30, 30-40,\u00a0>40), respectively.\nRESULTS: MELD (p\u00a0<\u00a00.001) and presence of HCC (p\u00a0=\u00a00.008) were independent risk factors for early and late mortality, respectively. Total tumor volume (p\u00a0=\u00a00.008) and alpha-fetoprotein (p\u00a0=\u00a00.013) were independent predictors of recurrence and mortality used for division of HCC patients into low-, moderate-, and high-risk subgroups, with disease-free survival rates of 74.9% (5\u00a0years), 51.7% (5\u00a0years), and 8.0% (3\u00a0years), respectively (p\u00a0<\u00a00.001). There were no differences in 5-year overall survival between low-risk HCC (74.9%) and non-HCC (81.9%) patients (p\u00a0=\u00a00.210), moderate-risk HCC (63.3%) and non-HCC (68.0%) patients (p\u00a0=\u00a00.372), and high-risk HCC (55.0%) and non-HCC (56.0%) patients (p\u00a0=\u00a00.559).\nCONCLUSIONS: The principle of utility is unequally applied for restriction of access to liver transplantation for HCC patients. The results provide rationale for discussion on reinitiation of liver transplantation for advanced HCCs.", 
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29 schema:description BACKGROUND: Although transplant benefit appears superior for patients with advanced hepatocellular cancer (HCC), liver transplantation remains limited to selected low-risk HCC patients to keep their outcomes similar to heterogeneous group of non-HCC patients. The purpose of this study was to assess the rationale for current policy of restricting access to liver transplantation to minority of HCC patients based on utility principle. METHODS: This retrospective cohort study comprised 1246 liver transplant recipients, including 206 HCC and 1040 non-HCC patients. Patient survival was the primary outcome measure. Patients with HCC and benign diseases were divided into low-, moderate-, and high-risk subgroups basing on independent risk factors for disease-free survival and model for end-stage liver disease (MELD) score (<30, 30-40, >40), respectively. RESULTS: MELD (p < 0.001) and presence of HCC (p = 0.008) were independent risk factors for early and late mortality, respectively. Total tumor volume (p = 0.008) and alpha-fetoprotein (p = 0.013) were independent predictors of recurrence and mortality used for division of HCC patients into low-, moderate-, and high-risk subgroups, with disease-free survival rates of 74.9% (5 years), 51.7% (5 years), and 8.0% (3 years), respectively (p < 0.001). There were no differences in 5-year overall survival between low-risk HCC (74.9%) and non-HCC (81.9%) patients (p = 0.210), moderate-risk HCC (63.3%) and non-HCC (68.0%) patients (p = 0.372), and high-risk HCC (55.0%) and non-HCC (56.0%) patients (p = 0.559). CONCLUSIONS: The principle of utility is unequally applied for restriction of access to liver transplantation for HCC patients. The results provide rationale for discussion on reinitiation of liver transplantation for advanced HCCs.
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37 Liver Disease score
38 MELD
39 access
40 advanced hepatocellular cancer
41 alpha-fetoprotein
42 barriers
43 benefits
44 benign disease
45 cancer
46 cohort study
47 current policy
48 differences
49 discussion
50 disease
51 disease score
52 disease-free survival
53 disease-free survival rates
54 division
55 end-stage liver disease (MELD) score
56 factors
57 group
58 hepatocellular cancer
59 heterogeneous group
60 high-risk HCC
61 high-risk subgroups
62 independent predictors
63 independent risk factor
64 late mortality
65 liver transplant recipients
66 liver transplantation
67 low-risk HCC
68 low-risk HCC patients
69 measures
70 minority
71 model
72 moderate-risk HCC
73 mortality
74 non-HCC patients
75 outcome measures
76 outcomes
77 overall survival
78 patient survival
79 patients
80 policy
81 predictors
82 presence
83 presence of HCC
84 primary outcome measure
85 principle of utility
86 principles
87 purpose
88 rate
89 rationale
90 recipients
91 recurrence
92 reinitiation
93 restriction
94 restriction of access
95 results
96 retrospective cohort study
97 risk factors
98 scores
99 study
100 subgroups
101 survival
102 survival rate
103 total tumor volume
104 transplant benefit
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