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UNOS Down-Staging Criteria for Liver Transplantation of Hepatocellular Carcinoma: Systematic Review and Meta-Analysis of 25 Studies

Authors
 Darren Jun Hao Tan  ;  Wen Hui Lim  ;  Jie Ning Yong  ;  Cheng Han Ng  ;  Mark D Muthiah  ;  Eunice X Tan  ;  Jieling Xiao  ;  Snow Yunni Lim  ;  Ansel Shao Pin Tang  ;  Xin Hui Pan  ;  Tousif Kabir  ;  Glenn K Bonney  ;  Raghav Sundar  ;  Nicholas Syn  ;  Beom Kyung Kim  ;  Yock Young Dan  ;  Mazen Noureddin  ;  Rohit Loomba  ;  Daniel Q Huang 
Citation
 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol.21(6) : 1475-1484, 2023-06 
Journal Title
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
ISSN
 1542-3565 
Issue Date
2023-06
MeSH
Adult ; Carcinoma, Hepatocellular* / pathology ; Humans ; Liver Neoplasms* / pathology ; Liver Transplantation* / adverse effects ; Neoplasm Recurrence, Local / pathology ; Neoplasm Staging ; Retrospective Studies ; Treatment Outcome
Keywords
Down-Staging ; Hepatocellular Carcinoma ; Liver Transplantation
Abstract
BACKGROUND & AIMS: Down-staging is commonly used to select patients with hepatocellular carcinoma (HCC) beyond Milan criteria (MC) for liver transplantation (LT), but outcomes are heterogenous. We aimed to estimate pooled down-staging success rates, HCC recurrence, and overall survival (OS), strati-fied by criteria used for baseline tumor burden. METHODS: We searched Pubmed and EMBASE databases from inception until August 2021 for studies reporting down-staging success (reduction of tumor burden to within MC) and outcomes of adult HCC patients. In addition, we performed a pooled analysis using reconstructed individual participant data to obtain robust estimates for OS.RESULTS: We screened 1059 articles and included 25 articles involving 3997 patients. Overall, 55.16% (45.49%-64.46%) underwent successful down-staging, and 31.52% (24.03%-40.11%) received LT (by intention-to-treat analysis [ITT]). Among patients who received LT, 16.01% (11.80%- 21.37%) developed HCC recurrence. Comparing studies that used the United Network for Organ Sharing Down-Staging (UNOS-DS) criteria versus studies beyond UNOS-DS or did not specify criteria, down-staging success (by ITT) was 83.21% versus 45.93%, P < .001; the proportion who received LT (by ITT) was 48.61% vs 28.60%, P [ .030; and HCC recurrence (among pa-tients who received LT) occurred in 9.06% versus 20.42%, P < .001. Among studies that used UNOS-DS criteria, ITT 1-and 5-year OS from the initiation of down-staging treatment was 86% and 58%, respectively, whereas 1-and 5-year post-LT OS was 94% and 74%, respectively.CONCLUSIONS: Among studies that adhered to UNOS-DS criteria, down-staging was successful in four -fifths of patients, >50% received LT, and post-LT outcomes were excellent. These data provide clinical validation for the utilization of UNOS-DS criteria.
Full Text
https://www.sciencedirect.com/science/article/pii/S1542356522001446
DOI
10.1016/j.cgh.2022.02.018
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198516
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