Alocação de transplante hepático por critérios milan pode excluir pacientes elegíveis com CHC sem benefício de sobrevivência - uma análise pós-hoc do estudo SiLVER

Resumo original em inglês

O que aconteceu

Selection criteria for liver transplant allocation are crucial for benefit-risk assessment of every patient evaluated for liver transplantation (LTx). Currently, Milan criteria are the key decision tool in several countries to assess whether a patient with hepatocellular carcinoma (HCC) is eligible for LTx. In this post-hoc analysis of the SiLVER Study, we analysed the performance of Milan criteria compared to the broader criteria UCSF, Up-to-7 and MT 2.0 to assess whether there is need to reform the selection process of HCC patients evaluated for LTx.

Outcomes of 485 patients of the multicentre and randomized SiLVER Study were analysed determined by recurrence-free survival (RFS), overall survival (OS) and freedom of tumor (FoT).

O que encontraram

Discrimination was modest for all four criteria and showed no statistically significant differences across OS (C-index 0.55-0.57), RFS (0.57-0.59) or FoT (0.62-0.64), with Metroticket 2.0 numerically highest. In the competing-risks analysis, being outside any criterion was associated with an increased subdistribution hazard of recurrence (sHR 2.7-3.6, all p < 0.001). The broader criteria classified substantially more patients as eligible (Up-to-7 83.9% vs Milan 65.6%).

Por que isso importa

Our data based on explant histopathology suggest that Milan criteria exclude patients with HCC evaluated for LTx without demonstrable benefit, questioning Milan criteria as sole selection tool in many regions doing liver transplants.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.