We have located links that may give you full text access.
Recipient hepatectomy technique may affect oncological outcomes of Liver Transplantation for hepatocellular carcinoma.
Liver Transplantation 2024 April 1
BACKGROUND: To date, caval sparing (CS) and total caval replacement (TCR) for recipient hepatectomy in liver transplantation (LT) have been compared only in terms of surgical morbidity. Nonetheless, CS technique is inherently associated with an increased manipulation of the native liver and later exclusion of the venous outflow, which may increase the risk of intraoperative shedding of tumor cells when LT is performed for hepatocellular carcinoma (HCC).
METHODS: A multicenter, retrospective study was performed to assess the impact of recipient hepatectomy (CS vs. TCR) on the risk of post-transplant HCC recurrence, among 16 European Transplant Centers that used either TCR or CS recipient hepatectomy, as elective protocol technique. Exclusion criteria comprised cases of non-Center-protocol recipient hepatectomy technique, living-donor LT, HCC diagnosis suspected on preoperative imaging but not confirmed at pathological examination of the explanted liver, HCC in close contact with the inferior vena cava and previous liver resection for HCC.
RESULTS: In 2420 patients, CS and TCR approaches were used in 1452 (60%) and 968 (40%) cases, respectively. Group adjustment with inverse probability weighting was performed for high volume center, recipient age, alcohol abuse, viral hepatitis, Child-Pugh class C, MELD score, cold ischemia time, clinical HCC stage within Milan criteria, pre-LT downstaging/bridging therapies, pre-LT AFP serum levels, number and size of tumor nodules, microvascular invasion and complete necrosis of all tumor nodules (matched cohort, TCR, n=938; CS, n=935). In a multivariate cause-specific hazard model, CS was associated with a higher risk of HCC recurrence(HR 1.536, p=0.007).
CONCLUSIONS: TCR recipient hepatectomy, compared to CS approach, may be associated with some protective effect against post-LT tumor recurrence.
METHODS: A multicenter, retrospective study was performed to assess the impact of recipient hepatectomy (CS vs. TCR) on the risk of post-transplant HCC recurrence, among 16 European Transplant Centers that used either TCR or CS recipient hepatectomy, as elective protocol technique. Exclusion criteria comprised cases of non-Center-protocol recipient hepatectomy technique, living-donor LT, HCC diagnosis suspected on preoperative imaging but not confirmed at pathological examination of the explanted liver, HCC in close contact with the inferior vena cava and previous liver resection for HCC.
RESULTS: In 2420 patients, CS and TCR approaches were used in 1452 (60%) and 968 (40%) cases, respectively. Group adjustment with inverse probability weighting was performed for high volume center, recipient age, alcohol abuse, viral hepatitis, Child-Pugh class C, MELD score, cold ischemia time, clinical HCC stage within Milan criteria, pre-LT downstaging/bridging therapies, pre-LT AFP serum levels, number and size of tumor nodules, microvascular invasion and complete necrosis of all tumor nodules (matched cohort, TCR, n=938; CS, n=935). In a multivariate cause-specific hazard model, CS was associated with a higher risk of HCC recurrence(HR 1.536, p=0.007).
CONCLUSIONS: TCR recipient hepatectomy, compared to CS approach, may be associated with some protective effect against post-LT tumor recurrence.
Full text links
Related Resources
Trending Papers
Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition).Regional Anesthesia and Pain Medicine 2025 January 29
Diastolic Dysfunction and Renal Disease: Analysis, Mechanisms, and Different Perspectives.Curēus 2025 January
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app