International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria
Helena Degroote, Federico Piñero, Charlotte Costentin, Andrea Notarpaolo, Ilka de Fátima Santana Ferreira Boin, Karim Boudjéma, Cinzia Baccaro, Aline Lopes Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poníachik, Fabrice Muscari, Fabrio Di Benedetto, Sergio Hoyos Duque, Ephrem Salamé, Umberto Cillo, Adrián Gadano, Claire Vanlemmens, S. Fagiuoli, Fernando Rubinstein, Patrizia Burra, Daniel Cherqui, Marcelo Silva, Hans Van Vlierberghe, Christophe Duvoux, Karim Boudjéma, Philippe Bachellier, Filoména Conti, Olivier Scatton, Fabrice Muscari, Ephrem Salamé, Pierre Bernard, Claire Francoz, François Durand, Sébastien Dharancy, Marie-lorraine Woehl, Claire Vanlemmens, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Daniel Cherqui, Louise Barbier, Pauline Houssel‐Debry, Georges Philippe Pageaux, L. Chiche, V DELEDINGHEN, Jean Hardwigsen, J. Gugenheim, Mario Altieri, Marie Noelle Hilleret, Thomas Decaens, Daniel Cherqui, Christophe Duvoux, Federico Piñero, Aline Lopes Chagas, Paulo Everton Garcia Costa, Elaine Cristina de Ataíde, Emilio Quiñones, Sergio Hoyos Duque, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Jaime Poníachik, Alejandro Soza, Martín Padilla, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatobá, Linda E. Muñoz‐Espinosa, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, Martín Fauda, Ariel González Campaña, Lucas McCormack, Juan Mattera, Adrián Gadano, Ilka S.F. Fatima Boin, Jose Huygens Parente García, Flair José Carrilho, Marcelo Silva, Andrea Notarpaolo, Giulia Magini, L. Miglioresi, Martina Gambato, Fabrizio Di Benedetto, C. D’Ambrosio, Giuseppe Maria Ettorre, Alessandro Vitale, Patrizia Burra, S. Fagiuoli, Umberto Cillo, M. Colledan, D. Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti
Abstract
BACKGROUND & AIMS: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and 'all-comers'. METHODS: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. RESULTS: = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP ≤20 ng/ml in all-comers. CONCLUSIONS: Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of ≤20 ng/ml might be a novel tool to optimise selection of candidates for LT. CLINICAL TRIAL NUMBER: This study was registered as part of an open public registry (NCT03775863). LAY SUMMARY: Patients with more extended HCC (within the UCSF-DS protocol) successfully downstaged to the conventional Milan criteria do not have a higher recurrence rate after LT compared with the group remaining in the Milan criteria from listing to transplantation. Moreover, in the UCSF-DS patient group, an ALP value equal to or below 20 ng/ml at listing might be a novel tool to further optimise selection of candidates for LT.