Jan-Paul Gundlach, Mark Ellrichmann, Marieke van Rosmalen, Serge Vogelaar, Christine Eimer, Corinna Rheinbay, Sabina Rösgen, Jost-Philipp Schäfer, Thomas Becker, Michael Linecker, Felix Braun
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Liver transplantation for HCC in cirrhosis: Are Milan criteria outdated?
In Germany, organ allocation is based on the MELD-system and lab-MELD is usually low in patients with hepatocellular carcinoma (HCC) in cirrhosis. Higher medical urgency can be achieved by standard exception for HCC (SE-HCC), if Milan criteria (MC) are met. Noteworthy, UNOS T2 reflects MC, but excludes singular lesions < 2 cm. Thus, SE-HCC is awarded to patients with one lesion between 2 and 5 cm or 2 to 3 lesions between 1 and 3 cm. These criteria are static and do not reflect biological properties of HCC.We present a retrospective cohort of 111 patients, who underwent liver transplantation at UKSH, Campus Kiel between 2007 and 2017. No difference was found in overall survival for patient cohorts using Milan, UCSF, up-to-seven, and French-AFP criteria. However, there was a significantly reduced survival, if microvascular invasion was detected in the explanted organ and in patients with HCC-recurrence. The exclusive use of static selection criteria including MC appear to limit the access to liver transplantation.
期刊介绍:
Die Zeitschrift für Gastroenterologie ist seit über 50 Jahren die führende deutsche Fachzeitschrift auf dem Gebiet der Gastroenterologie. Sie richtet sich an Gastroenterologen und alle anderen gastroenterologisch interessierten Ärzte. Als offizielles Organ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten sowie der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie informiert sie zuverlässig und aktuell über die wichtigen Neuerungen und Entwicklungen in der Gastroenterologie.