Resultados oncológicos pós-transplante após redução locorregional antes do transplante hepático de doadores vivos para carcinoma hepatocelular além dos critérios de Milão: revisão sistemática e metanálise de coortes selecionadas

Resumo original em inglês

O que aconteceu

Downstaging of hepatocellular carcinoma (HCC) before liver transplantation is established mainly in the deceased donor setting, and outcomes before living donor liver transplantation (LDLT) remain unclear. We searched PubMed and Embase through April 2026 for studies reporting post-transplant outcomes in patients with HCC beyond Milan criteria who were downstaged before LDLT. A pre-specified primary analysis covered locoregional therapy targeting Milan or UCSF criteria. We pooled proportions using random-effects models and reconstructed patient-level survival from Kaplan-Meier curves. Seventeen studies with 511 downstaged LDLT recipients were included. In the primary cohort, recurrence was 22.1% (95% CI 9.7-42.6) and 5-year overall survival 75.8% (61.8-85.8). Across all studies, recurrence was 25.0% (17.4-34.5), 5-year overall survival 75.0% (63.1-84.1), and downstaging success 47.5% (36.1-59.1); reconstructed 5-year overall and recurrence-free survival were 75.7% and 75.6%. These estimates describe patients who achieved downstaging-fewer than half of those who attempted it-and then reached transplant. They do not measure the benefit of downstaging itself. The evidence remains retrospective and mostly Asian, with wide variation between studies. Prospective intention-to-treat studies are needed.

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