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Costentin C, Piñero F, Degroote H, Notarpaolo A, Boin IF, Boudjema K, Baccaro C, Podestá LG, Bachellier P, Ettorre GM, Poniachik J, Muscari F, Dibenedetto F, Hoyos Duque S, Salame E, Cillo U, Marciano S, Vanlemmens C, Fagiuoli S, Burra P, Van Vlierberghe H, Cherqui D, Lai Q, Silva M, Rubinstein F, Duvoux C, Boudjema K, Bachellier P, Conti F, Scatton O, Muscari F, Salame E, Bernard PH, Francoz C, Durand F, Dharancy S, Woehl ML, Vanlemmens C, Laurent A, Radenne S, Dumortier J, Abergel A, Cherqui D, Barbier L, Houssel-Debry P, Pageaux GP, Chiche L, Deledinghen V, Hardwigsen J, Gugenheim J, altieri M, Hilleret MN, Decaens T, Duvoux C, Piñero F, Chagas A, Costa P, Cristina de Ataide E, Quiñones E, Duque SH, Marciano S, Anders M, Varón A, Zerega A, Poniachik J, Soza A, Machaca MP, Arufe D, Menéndez J, Zapata R, Vilatoba M, Muñoz L, Menéndez RC, Maraschio M, Podestá LG, McCormack L, Mattera J, Gadano A, Fatima Boin ISF, Parente García JH, Carrilho F, Silva M, Notarpaolo A, Magini G, Miglioresi L, Gambato M, Benedetto FD, D’Ambrosio C, Ettorre GM, Vitale A, Burra P, Fagiuoli S, Cillo U, Colledan M, Pinelli D, Magistri P, Vennarecci G, Colasanti M, Giannelli V, Pellicelli A, Baccaro C, Lai Q, Degroote H, Vlierberghe HV, Eduard C, Samuele I, Jeroen D, Jonas S, Jacques P, Chris V, Dirk Y, Peter M, Valerio L, Christophe M, Olivier D, Jean D, Roberto T, Paul LJ. R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation. JHEP Rep 2022; 4:100445. [PMID: 35360522 PMCID: PMC8961219 DOI: 10.1016/j.jhepr.2022.100445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background & Aims Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration NCT03775863. Lay summary Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT. Discrepancies between pretransplant tumour assessment and liver explant are frequent. The R3-AFP predictive model of recurrence was designed and validated in a large and international cohort of patients transplanted for HCC. The components of the final model are the following: number of nodules, size of the largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value. The R3-AFP model including the last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a standardised framework to refine post-LT management of patients, irrespective of criteria used to select patients with HCC for LT.
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Davalos Moscol M, Tagle Arróspide M, Padilla Machaca M, Montes Teves P. [Peruvian experience in the treatment of chronic hepatites C with the new direct acting antiviral drugs]. Rev Gastroenterol Peru 2019; 39:45-54. [PMID: 31042236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The ideal therapy for chronic hepatitis C is the use of direct acting antivirals (DAA). In Peru there is no data in this aspect, in that sense it is necessary to report real life experience with these drugs. MATERIAL AND METHODS A digital survey was sent through e-mail to hepatologists, and the data of four is considered in this study. Statistical analysis was descriptive. RESULTS We included 63 patients, mean age was 59 years, 49.21% were male, cirrhosis was present in 49.21%, and 34.92% was non-responder to PEGIFN and Ribavirin. Genotype 1 was present in 93.65%, and subtype 1a was 58.73%, there were only 2 cases with Gt 2 and one with Gt 3. There were 10 different DAA combinations used, and the most effective were Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir, in all these cases the Sustained Viral Response (SVR) was 100%. The other combinations had SVR < 90% or only 1-2 patients included. All patients tolerated treatments and no serious adverse events occurred. CONCLUSIONS In real life antiviral treatment for hepatitis C with AAD is effective and well tolerated. The best SVR was obtained with Sofosbuvir/Ledipasvir, Sofosbuvir/Ledipasvir/Ribavirina and Sofosbuvir/Simeprevir. This report may be useful to consider treatment strategies with focus in public health.
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Piñero F, Costa P, Boteon YL, Duque SH, Marciano S, Anders M, Varón A, Zerega A, Poniachik J, Soza A, Padilla Machaca M, Menéndez J, Zapata R, Vilatoba M, Muñoz L, Maraschio M, Podestá LG, McCormack L, Gadano A, Boin ISFF, García P, Silva M. A changing etiologic scenario in liver transplantation for hepatocellular carcinoma in a multicenter cohort study from Latin America. Clin Res Hepatol Gastroenterol 2018; 42:443-452. [PMID: 29773419 DOI: 10.1016/j.clinre.2018.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is an increasing cause of hepatocellular carcinoma (HCC) and liver transplantation (LT). Our study focused on changing trends of liver related HCC etiologies during the last years in Latin America. METHODS From a cohort of 2761 consecutive adult LT patients between 2005 and 2012 in 17 different centers, 435 with HCC were included. Different periods including years 2005-2006, 2007-2008, 2009-2010 and 2011-2012 were considered. Etiology of liver disease was confirmed in the explant. RESULTS Participating LT centers per country included 2 from Brazil (n=191), 5 transplant programs from Argentina (n=98), 2 from Colombia (n=65), 4 from Chile (n=49), 2 from Mexico (n=12), and 1 from Peru (n=11) and Uruguay (n=9). Chronic hepatitis C infection was the leading cause of HCC in the overall cohort (37%), followed by HBV (25%) and alcoholic liver disease (17%). NAFLD and cryptogenic cirrhosis accounted for 6% and 7%, respectively. While HCV decreased from 48% in 2005-06 to 26% in 2011-12, NAFLD increased from 1.8% to 12.8% during the same period, accounting for the third cause of HCC. This represented a 6-fold increase in NAFLD-HCC, whereas HCV had a 2-fold decrease. Patients with NAFLD were older, had lower pre-LT serum AFP values and similar 5-year survival and recurrence rates than non-NAFLD. CONCLUSION There might be a global changing figure regarding etiologies of HCC in Latin America. This epidemiological change on the incidence of HCC in the world, although it has been reported, should still be confirmed in prospective studies.
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Affiliation(s)
- Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Austral University, School of Medicine, avenue Presidente-Perón 1500, (B1629HJ) Pilar, Buenos Aires, Argentina.
| | - Paulo Costa
- Hospital Federal University of Ceará, Ceara, Brazil
| | | | - Sergio Hoyos Duque
- Hospital Pablo Tobón Uribe and Gastroenterology group from Universidad de Antioquía, Medellín, Colombia
| | | | | | - Adriana Varón
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Alina Zerega
- Sanatorio Allende from Córdoba, Córdoba, Argentina
| | - Jaime Poniachik
- Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Alejandro Soza
- Hospital Universidad Católica de Chile, Santiago de Chile, Chile
| | | | | | - Rodrigo Zapata
- Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago de Chile, Chile; Hospital del Salvador, Universidad de Chile, Santiago de Chile, Chile
| | | | - Linda Muñoz
- Hospital Universitario de Monterrey, Monterrey, Mexico
| | | | - Luis G Podestá
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Austral University, School of Medicine, avenue Presidente-Perón 1500, (B1629HJ) Pilar, Buenos Aires, Argentina
| | | | - Adrian Gadano
- Hospital Italiano from Buenos Aires, Buenos Aires, Argentina
| | | | | | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Austral University, School of Medicine, avenue Presidente-Perón 1500, (B1629HJ) Pilar, Buenos Aires, Argentina
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Piñero F, Costa P, Boteon YL, Duque SH, Marciano S, Anders M, Varón A, Zerega A, Poniachik J, Soza A, Machaca MP, Menéndez J, Zapata R, Vilatoba M, Muñoz L, Maraschio M, Fauda M, McCormack L, Gadano A, Boin IS, García JHP, Silva M. Results of Liver Transplantation for Hepatocellular Carcinoma in a Multicenter Latin American Cohort Study. Ann Hepatol 2018; 17:256-267. [PMID: 29469048 DOI: 10.5604/01.3001.0010.8648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Heterogeneous data has been reported regarding liver transplantation (LT) for hepatocellular carcinoma (HCC) in Latin America. We aimed to describe treatment during waiting list, survival and recurrence of HCC after LT in a multicenter study from Latin America. MATERIAL AND METHODS Patients with HCC diagnosed prior to transplant (cHCC) and incidentally found in the explanted liver (iHCC) were included. Imaging-explanted features were compared in cHCC (non-discordant if pre and post-LT were within Milan, discordant if pre-LT was within and post-LT exceeding Milan). RESULTS Overall, 435 patients with cHCC and 92 with iHCC were included. At listing, 81% and 91% of cHCC patients were within Milan and San Francisco criteria (UCSF), respectively. Five-year survival and recurrence rates for cHCC within Milan, exceeding Milan/within UCSF and beyond UCSF were 71% and 16%; 66% and 26%; 46% and 55%, respectively. Locoregional treatment prior to LT was performed in 39% of cHCC within Milan, in 53% beyond Milan/within UCSF and in 83% exceeding UCSF (p < 0.0001). This treatment difference was not observed according to AFP values (≤100, 44%; 101-1,000, 39%, and > 1,000 ng/mL 64%; p = 0.12). Discordant imaging-explanted data was observed in 29% of cHCC, showing lower survival HR 2.02 (CI 1.29; 3.15) and higher recurrence rates HR 2.34 when compared to AFP <100 ng/mL. Serum AFP > 1,000 ng/mL at listing was independently associated with a higher 5-year recurrence rate and a HR of 3.24 when compared to AFP <100 ng/mL. CONCLUSION Although overall results are comparable to other regions worldwide, pre-LT treatment not only considering imaging data but also AFP values should be contemplated during the next years.
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Affiliation(s)
- Federico Piñero
- Hospital Universitario Austral. Austral University, Faculty of Medicine. Argentina
| | - Paulo Costa
- Hospital Federal University of Ceará, Brazil
| | - Yuri L Boteon
- Hospital de Clinicas, State University of Campinas, Brazil
| | - Sergio Hoyos Duque
- Hospital Pablo Tobón Uribe and Gastroenterology group from Universidad de Antioquía, Medellín, Colombia
| | | | | | - Adriana Varón
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | | | | | | | | | | | - Rodrigo Zapata
- Clinica Alemana de Santiago, Universidad del Desarrollo, Chile
| | | | | | | | - Martín Fauda
- Hospital Universitario Austral. Austral University, Faculty of Medicine. Argentina
| | | | | | - Ilka Sf Boin
- Hospital de Clinicas, State University of Campinas, Brazil
| | | | - Marcelo Silva
- Hospital Universitario Austral. Austral University, Faculty of Medicine. Argentina. On behalf of the Latin American Liver Research, Education and Awareness Network (LALREAN)
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Piñero F, Tisi Baña M, de Ataide EC, Hoyos Duque S, Marciano S, Varón A, Anders M, Zerega A, Menéndez J, Zapata R, Muñoz L, Padilla Machaca M, Soza A, McCormack L, Poniachik J, Podestá LG, Gadano A, Boin ISFF, Duvoux C, Silva M. Liver transplantation for hepatocellular carcinoma: evaluation of the alpha-fetoprotein model in a multicenter cohort from Latin America. Liver Int 2016; 36:1657-1667. [PMID: 27169841 DOI: 10.1111/liv.13159] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The French alpha-fetoprotein (AFP) model has recently shown superior results compared to Milan criteria (MC) for prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) in European populations. The aim of this study was to explore the predictive capacity of the AFP model for HCC recurrence in a Latin-American cohort. METHODS Three hundred twenty-seven patients with HCC were included from a total of 2018 patients transplanted at 15 centres. Serum AFP and imaging data were both recorded at listing. Predictability was assessed by the Net Reclassification Improvement (NRI) method. RESULTS Overall, 82 and 79% of the patients were within MC and the AFP model respectively. NRI showed a superior predictability of the AFP model against MC. Patients with an AFP score >2 points had higher risk of recurrence at 5 years Hazard Ratio (HR) of 3.15 (P = 0.0001) and lower patient survival (HR = 1.51; P = 0.03). Among patients exceeding MC, a score ≤2 points identified a subgroup of patients with lower recurrence (5% vs 42%; P = 0.013) and higher survival rates (84% vs 45%; P = 0.038). In cases treated with bridging procedures, following restaging, a score >2 points identified a higher recurrence (HR 2.2, P = 0.12) and lower survival rate (HR 2.25, P = 0.03). A comparative analysis between HBV and non-HBV patients showed that the AFP model performed better in non-HBV patients. CONCLUSIONS The AFP model could be useful in Latin-American countries to better select patients for LT in subgroups presenting with extended criteria. However, particular attention should be focused on patients with HBV.
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Affiliation(s)
| | | | | | - Sergio Hoyos Duque
- Hospital Pablo Tobón Uribe, Medellin, Colombia.,Universidad de Antioquía, Medellin, Colombia
| | | | - Adriana Varón
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | | | - Alina Zerega
- Sanatorio Allende from Córdoba, Córdoba, Argentina
| | | | - Rodrigo Zapata
- Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.,Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Linda Muñoz
- Hospital Universitario de Monterrey, Monterrey, Mexico
| | | | | | | | | | | | - Adrian Gadano
- Hospital Italiano from Buenos Aires, Buenos Aires, Argentina
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