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Abstract Details
Liver Transplantation for Hepatocellular Carcinoma: A Real-Life Comparison of Milan Criteria and AFP Model
Cancers (Basel). 2021 May 19;13(10):2480. doi: 10.3390/cancers13102480.
Bleuenn Brusset12, Jerome Dumortier3, Daniel Cherqui4, Georges-Philippe Pageaux5, Emmanuel Boleslawski6, Ludivine Chapron2, Jean-Louis Quesada2, Sylvie Radenne7, Didier Samuel4, Francis Navarro5, Sebastien Dharancy6, Thomas Decaens128
Author information
1Faculty of Medicine, University Grenoble-Alpes, 38000 Grenoble, France.
2CHU Grenoble-Alpes, 38000 Grenoble, France.
3Hospices Civiles de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France.
4Assistance Publique des Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépato-Biliaire, 94800 Villejuif, France.
5CHU de Montpellier, 34295 Montpellier, France.
6CHU de Lille, 59000 Lille, France.
7Hospices Civiles de Lyon, Hôpital de la Croix Rousse, 69004 Lyon, France.
8Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, 38000 Grenoble, France.
Abstract
Purpose: To compare the agreement for the criteria on the explant and the results of liver transplantation (LT) before and after adoption of the AFP (α-fetoprotein) model.
Methods: 523 patients consecutively listed in five French centers were reviewed to compare results of the Milan criteria period (MilanCP, n = 199) (before 2013) and the AFP score period (AFPscP, n = 324) (after 2013). (NCT03156582).
Results: During AFPscP, there was a significantly longer waiting time on the list (12.3 vs. 7.7 months, p < 0.001) and higher rate of bridging therapies (84 vs. 75%, p = 0.012) compared to the MilanCP. Dropout rate was slightly higher in the AFPscP (31 vs. 24%, p = 0.073). No difference was found in the histological AFP score between groups (p = 0.838) with a global agreement in 88% of patients. Post-LT recurrence was 9.2% in MilanCP vs. 13.2% in AFPscP (p = 0.239) and predictive factors were AFP > 2 on the last imaging, downstaging policy and salvage transplantation. Post-LT survival was similar (83 vs. 87% after 2 years, p = 0.100), but after propensity score analysis, the post-listing overall survival (OS) was worse in the AFPscP (HR 1.45, p = 0.045).
Conclusions: Agreement for the AFP model on explant analysis (≤2) did not significantly change. AFP score > 2 was the major prognostic factor for recurrence. Graft allocation policy has a major impact on prognosis, with a post-listing OS significantly decreased, probably due to the increase in waiting time, increase in bridging therapies, downstaging policy and salvage transplantation.