The potential use of extended criteria donors and eligible recipients in liver transplantation for unresectable colorectal liver metastases in Central Sweden.
Colorectal cancer (CRC)
extended criteria donor
liver transplantation (LT)
unresectable colorectal liver metastases (unresectable CRLM)
Journal
Hepatobiliary surgery and nutrition
ISSN: 2304-3881
Titre abrégé: Hepatobiliary Surg Nutr
Pays: China (Republic : 1949- )
ID NLM: 101600750
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
16
11
2019
accepted:
03
03
2020
entrez:
25
8
2021
pubmed:
26
8
2021
medline:
26
8
2021
Statut:
ppublish
Résumé
Unresectable colorectal liver metastases (CRLM) is a condition with poor prognosis. A recent treatment alternative improving survival in patients with unresectable CRLM, has emerged with the introduction of liver transplantation (LT), yet not uncontroversial with the current organ shortage. This study aimed to retrospectively investigate the potential of declined donors with acceptable risk as liver graft donors and patients with unresectable CRLM as potential recipients. All declined donors in central Sweden and all patients with CRLM discussed at multidisciplinary team conference at Karolinska University Hospital, January 2013-October 2018, were identified. Donors were classified according to the European Committee Guide to the quality and safety of organs for transplantation and potential recipients were evaluated by selection criteria, based on studies on the Norwegian Secondary Cancer study database. Out of 1,462 evaluated potential donors, 62 (2.7 pmp) donors were identified, corresponding to 6-18% of the utilized donor pool. Out of 1,008 included patients with CRLM, 25 (2.1 pmp) potential recipients were recognized. Eligibility for LT and left-sided colon cancer were favorable prognostic factors. Today's donor pool could increase with the use of extended criteria donors, which is sufficient and display an acceptable risk-benefit ratio for patients with unresectable CRLM. With current selection criteria a small subset of patients with unresectable CRLM are eligible recipients. This subset of patients has a better survival compared to patients ineligible for LT.
Sections du résumé
BACKGROUND
BACKGROUND
Unresectable colorectal liver metastases (CRLM) is a condition with poor prognosis. A recent treatment alternative improving survival in patients with unresectable CRLM, has emerged with the introduction of liver transplantation (LT), yet not uncontroversial with the current organ shortage. This study aimed to retrospectively investigate the potential of declined donors with acceptable risk as liver graft donors and patients with unresectable CRLM as potential recipients.
METHODS
METHODS
All declined donors in central Sweden and all patients with CRLM discussed at multidisciplinary team conference at Karolinska University Hospital, January 2013-October 2018, were identified. Donors were classified according to the European Committee Guide to the quality and safety of organs for transplantation and potential recipients were evaluated by selection criteria, based on studies on the Norwegian Secondary Cancer study database.
RESULTS
RESULTS
Out of 1,462 evaluated potential donors, 62 (2.7 pmp) donors were identified, corresponding to 6-18% of the utilized donor pool. Out of 1,008 included patients with CRLM, 25 (2.1 pmp) potential recipients were recognized. Eligibility for LT and left-sided colon cancer were favorable prognostic factors.
CONCLUSIONS
CONCLUSIONS
Today's donor pool could increase with the use of extended criteria donors, which is sufficient and display an acceptable risk-benefit ratio for patients with unresectable CRLM. With current selection criteria a small subset of patients with unresectable CRLM are eligible recipients. This subset of patients has a better survival compared to patients ineligible for LT.
Identifiants
pubmed: 34430526
doi: 10.21037/hbsn.2020.03.10
pii: hbsn-10-04-476
pmc: PMC8350992
doi:
Types de publication
Journal Article
Langues
eng
Pagination
476-485Commentaires et corrections
Type : CommentIn
Informations de copyright
2021 Hepatobiliary Surgery and Nutrition. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn.2020.03.10). The authors have no conflicts of interest to declare.
Références
Liver Int. 2018 Dec;38(12):2170-2177
pubmed: 29750389
Liver Transpl. 2018 Oct;24(10):1470-1475
pubmed: 30080954
J Natl Cancer Inst. 2011 Jan 5;103(1):21-30
pubmed: 21123833
Clin Transplant. 2011 Mar-Apr;25(2):270-6
pubmed: 20184629
J Clin Oncol. 2013 Jun 1;31(16):1931-8
pubmed: 23569301
Clin Epidemiol. 2012;4:283-301
pubmed: 23152705
J Clin Oncol. 2012 May 20;30(15):1755-62
pubmed: 22473155
Ann Oncol. 2017 Aug 1;28(8):1862-1868
pubmed: 28449055
J Clin Oncol. 2011 May 20;29(15):2011-9
pubmed: 21502544
N Engl J Med. 2009 Apr 2;360(14):1408-17
pubmed: 19339720
Oncologist. 2013;18(9):1004-12
pubmed: 23881988
Ann Oncol. 2016 Aug;27(8):1386-422
pubmed: 27380959
JAMA Oncol. 2017 Feb 1;3(2):211-219
pubmed: 27787550
Ann Surg. 2011 Nov;254(5):745-53; discussion 753
pubmed: 22042468
World J Gastroenterol. 2018 Oct 14;24(38):4403-4411
pubmed: 30344424
World J Gastroenterol. 2016 Sep 21;22(35):8010-6
pubmed: 27672295
Ann Surg. 2015 May;261(5):956-60
pubmed: 24950280
J Clin Oncol. 2010 Nov 1;28(31):4706-13
pubmed: 20921462
HPB (Oxford). 2018 May;20(5):441-447
pubmed: 29242035
Transpl Int. 2015 Nov;28(11):1345-9
pubmed: 26073850
J Clin Oncol. 2008 May 10;26(14):2311-9
pubmed: 18390971
Clin Transplant. 2015 Jul;29(7):636-43
pubmed: 25997000
Br J Surg. 2018 May;105(6):736-742
pubmed: 29532908
Ann Surg. 2013 May;257(5):800-6
pubmed: 23360920
Transpl Int. 2011 Apr;24(4):373-8
pubmed: 21392129
Clin Transplant. 2011 May-Jun;25(3):E243-9
pubmed: 21323735
J Clin Oncol. 2009 Aug 1;27(22):3677-83
pubmed: 19470929
Liver Transpl. 2017 Aug;23(8):1073-1076
pubmed: 28544246
Ann Surg. 2018 Aug;268(2):325-331
pubmed: 28549011
Medicine (Baltimore). 2016 May;95(20):e3722
pubmed: 27196492
Ann Surg. 2020 Feb;271(2):212-218
pubmed: 31188200
J Clin Oncol. 2010 Nov 1;28(31):4697-705
pubmed: 20921465