1
|
Galdino-Vasconcelos MR, Feijó MS, Ferro HM, Gomes ACR, De Almeida Santos ME, Ferreira G, Jorge F, Trevizoli N, Diaz LG, De Campos PB, Cajá G, Ullmann R, Figueira AV, Morato T, Watanabe ALC. Preoperative Alpha-Fetoprotein and Radiological Total Tumor Diameter as Predictors of Hepatocellular Carcinoma Recurrence After Liver Transplantation. Transplant Proc 2022; 54:1333-1340. [PMID: 35768294 DOI: 10.1016/j.transproceed.2022.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Liver transplantation is a unique treatment opportunity for patients with chronic liver disease and hepatocellular carcinoma (HCC). Selection of HCC patients for transplantation was revolutionized by Milan-based criteria, but tumor recurrence and shortage of organs are still a major concern. Nowadays, additional preoperative tumor parameters can help to refine the graft allocation process. The objective of this study was to evaluate the prognostic value and cut-off points of pretransplant serum alpha-fetoprotein (AFP) levels and radiological tumor parameters on liver transplantation outcomes. METHODS This is a single-team retrospective cohort of 162 consecutive deceased donor liver transplants (DDLT) with pathologically confirmed HCC. Pretransplant serum AFP levels and radiological tumor parameters were retrieved from a preoperative follow-up. Receiver-operating characteristics (ROC) curves were used to evaluate cut-off points for each outcome. Multivariate Cox regression model was used to assess the predictors of HCC relapse and recipient mortality. RESULTS Twelve recipients (7.4%) had HCC recurrence after transplantation, with median survival time of 5.8 months. Pretransplant AFP ≥30 ng/mL (hazard ratio [HR]: 13.84, P = .003) and radiological total tumor diameter (TTD) ≥5 cm (HR: 12.89, P = .005) were independent predictors for HCC relapse. Moreover, pretransplant AFP ≥150 ng/mL was independently associated with recipient mortality (HR: 4.45, P = .003). CONCLUSIONS Pretransplant AFP levels and radiological TTD were independently associated with HCC relapse and recipient mortality after DDLT, with different cut-off points predicting different outcomes. These findings may contribute to improving decision-making in the context of liver transplantation for HCC patients.
Collapse
Affiliation(s)
| | - Mateus Silva Feijó
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil.
| | - Henrique Metzker Ferro
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | - Ana Clara Ramalho Gomes
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | | | - Gustavo Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil
| | - Fernando Jorge
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Natália Trevizoli
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Luiz Gustavo Diaz
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Priscila Brizolla De Campos
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Gabriel Cajá
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Raquel Ullmann
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Ana Virgínia Figueira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Tiago Morato
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - André Luís Conde Watanabe
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| |
Collapse
|
2
|
Watanabe ALC, Feijó MS, Menezes VPLD, Galdino-Vasconcelos MR, Caballero JLS, Ferreira G, Jorge F, Trevizoli N, Diaz LG, Campos PBD, Cajá G, Ullmann R, Figueira AV, Morato T, Moraes A, Pereira JRB, Perosa M. 500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil. Transplant Proc 2021; 53:73-82. [PMID: 32981691 DOI: 10.1016/j.transproceed.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Liver transplantation is the standard treatment for end-stage liver disease. Brazil holds the third highest number of liver transplants performed per year, but center maldistribution results in high discrepancies in accessing this treatment. In 2012, an interstate partnership successfully implemented a new liver transplantation program in the middle west of Brazil. Here, we report the results of the first 500 liver transplants performed in this new program and discuss the impacts of a new transplant center in regional transplantation dynamics. METHODS We reviewed data from the first 500 consecutive deceased donor liver transplants performed in the new program during an 8-year period. We analyzed data on patients' clinical and demographic profiles, postoperative outcomes, and graft and recipient survival rates. Univariate survival analysis was conducted using log-rank tests to compare the groups. RESULTS Almost half (48%) of the procured organs and 40% of the recipients transplanted in our center were from outside our state. Recipient 30-day mortality was 9%. Overall recipient survival at 1 year and 5 years was 85% and 80%, respectively. Mortality was significantly associated with higher Model for End-Stage Liver Disease (P < .001) but not with the presence of hepatocellular carcinoma (P = .795). DISCUSSION The new transplantation program treated patients from different regions of Brazil and became the reference center in liver transplantation for the middle west region. Despite the recent implementation, our outcomes are comparable to experienced centers around the world. This model can inspire the creation of new transplantation programs aiming to democratize access to liver transplantation nationwide.
Collapse
Affiliation(s)
- André Luís Conde Watanabe
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Mateus Silva Feijó
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil.
| | | | | | - Jorge Luis Salinas Caballero
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | - Gustavo Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Fernando Jorge
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Natália Trevizoli
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Luiz Gustavo Diaz
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Priscila Brizolla de Campos
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Gabriel Cajá
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Raquel Ullmann
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Ana Virgínia Figueira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Tiago Morato
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Adriano Moraes
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Juan Rafael Branez Pereira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Marcelo Perosa
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| |
Collapse
|
3
|
Watanabe ALC, Feijó MS, Menezes VPLD, Galdino-Vasconcelos MR, Caballero JLS, Ferreira G, Jorge F, Trevizoli N, Diaz LG, Campos PBD, Cajá G, Ullmann R, Figueira AV, Morato T, Moraes A, Pereira JRB, Perosa M. 500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil. Transplant Proc 2021; 53:73-82. [DOI: https:/doi.org/10.1016/j.transproceed.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
|
4
|
Feijó MS, Galdino-Vasconcelos MR, Simões V, Atik F, Castro FFS, Ferreira G, Jorge F, Diaz LG, Brizolla de Campos P, Trevizoli N, Cajá G, Ullmann R, Watanabe A. Impact of Donor Positive Blood Culture in Deceased Donor Liver Transplantation. Transplant Proc 2020; 52:1236-1242. [PMID: 32217009 DOI: 10.1016/j.transproceed.2020.02.027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In the era of shortage of organs for donation, transplantation from suboptimal donors is an expanding alternative to minimize waitlist mortality. In that sense, the safety of using organs from bacteremic donors has been a recurrent matter of discussion. We aimed to evaluate the influence of donor positive blood culture in the recipient and graft outcomes after liver transplantation from deceased donors. MATERIAL AND METHODS Blood culture results from 255 deceased liver donors were retrospectively reviewed. Patients were categorized into 2 groups based on the recipients who obtained a graft from a donor with negative or positive blood culture. Graft and recipient outcomes were compared between the 2 groups using univariate survival analysis and multivariate regression models. Transmission of bloodstream infection from donor to recipient was assessed by reviewing recipients' microbiologic status when there was evidence of infection. RESULTS Positive blood culture in donors was not associated with negative outcomes after transplantation. Death within 30 days after transplantation and overall recipient and graft survival did not differ between the 2 groups. Only Child-Pugh score ≥10 and retransplantation status were considered independent predictors of recipient death and graft failure. We identified 1 potential case of bacteremia transmission from donor to recipient. CONCLUSION Donor positive blood culture was not associated with negative outcomes after liver transplantation. Transmission of infection from donor to recipient is possible, but rare. The results support the usage of bacteremic donors as a safe alternative to the scarcity of optimal donors.
Collapse
Affiliation(s)
| | | | - Viviann Simões
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Fernando Atik
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil; Cardiology Institute of Federal District, Brasilia, Brazil
| | | | | | - Fernando Jorge
- Cardiology Institute of Federal District, Brasilia, Brazil
| | | | | | | | - Gabriel Cajá
- Cardiology Institute of Federal District, Brasilia, Brazil
| | - Raquel Ullmann
- Cardiology Institute of Federal District, Brasilia, Brazil
| | - André Watanabe
- Faculty of Medicine, University of Brasilia, Brasilia, Brazil; Cardiology Institute of Federal District, Brasilia, Brazil
| |
Collapse
|
5
|
Feijó MS, Galdino-Vasconcelos MR, Simões V, Atik F, Castro FF, Ferreira G, Jorge F, Diaz LG, Brizolla de Campos P, Trevizoli N, Cajá G, Ullmann R, Watanabe A. Impact of Donor Positive Blood Culture in Deceased Donor Liver Transplantation. Transplant Proc 2020; 52:1236-1242. [DOI: https:/doi.org/10.1016/j.transproceed.2020.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
|
6
|
Salvalaggio PR, Felga GE, Guardia BD, Almeida MD, Pandullo FL, Matielo CE, Evangelista A, Curvelo L, Rocco RA, Alves JA, Meirelles RF, Filho SPM, de Rezende MB, Pedroso PT, Diaz LG, Rusi MB, Viveiros MM, Neves DB. Time of Dropout From the Liver Transplant List in Patients With Hepatocellular Carcinoma: Clinical Behavior According to Tumor Characteristics and Severity of Liver Disease. Transplant Proc 2017; 48:2319-2322. [PMID: 27742288 DOI: 10.1016/j.transproceed.2016.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prolonged time on the waiting list affects post-transplant survival of patients with hepatocellular carcinoma (HCC). However, it is not yet known which patients will be at higher risk for early dropout from the list. We investigate specific risk factors for early waiting list dropout in patients with HCC. METHODS This was a single-center, intention-to-treat analysis of adults with HCC, within the Milan criteria, from July 2006 through September 2013. Patients were divided into groups according to waiting list time. The main end point was dropout from the list. RESULTS The dropout rates of the study cohort at 3, 6, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Patients who dropped out from the list tended to be older, with blood types A and O, and with higher Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. They also had larger nodules, responded poorly to trans-arterial chemo-embolization (TACE), and had a higher alpha-fetoprotein. Those with blood types B and AB appeared to be protected for dropout (odds ratio [OR] = 0.21, P = .02). Patients who responded to TACE were also protected (OR = 0.22, P < .001). When we looked into time to dropout, the only baseline characteristic that stood out was a higher MELD score (13 for those dropping out up to 90 days vs 10 for those dropping out after 180 days, P = .0025). CONCLUSIONS We conclude that patients who drop out early from the list are primarily driven by the severity of liver disease. Patients who had progressive HCC had a high tumor load and poor response to loco-regional therapies, dropping out from the list after 180 days of inclusion.
Collapse
Affiliation(s)
- P R Salvalaggio
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - G E Felga
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - B D Guardia
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M D Almeida
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - F L Pandullo
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - C E Matielo
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - A Evangelista
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - L Curvelo
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R A Rocco
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - J A Alves
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - R F Meirelles
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - S P M Filho
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M B de Rezende
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - P T Pedroso
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - L G Diaz
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M B Rusi
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - M M Viveiros
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - D B Neves
- Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
7
|
Grinberg S, Jover P, Quiros L, Diaz LG, Terron F. Ectodermal dysplasia: report of two female cases. ASDC J Dent Child 1980; 47:193-5. [PMID: 6929801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
8
|
Jover P, Quiros L, Diaz LG, Herrero E. [Facial fractures in childhood]. Trib Odontol (B Aires) 1976; 60:18, 20, 22-4 passim. [PMID: 1075772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|