Resultados del trasplante hepático por hepatocarcinoma, según el cumplimiento de los criterios de Milán y su influencia en la supervivencia del injerto y global

Résumé

Objectives: The objectives of this doctoral thesis were to analyze the results, the graft survival, and the overall survival of patients with liver transplant by Hepatocarcinoma (HCC) in our center, within and beyond Milan Criteria (CM), considering the analysis of a subgroup of patients with expanded criteria that could benefit from an extension and to analyze the impact of such expansion on the incidence of post-transplant tumor recurrence. On the other hand, to analyze the impact of Age and DCD donation on the graft and overall survival of these patients. Methodology: Analytical, observational, longitudinal, and retrospective cohort study, based on 100 consecutive cases of liver transplanted patients between January 2011 and November 2017 at the Hospital Clínico Universitario Virgen de la Arrixaca with a diagnosis of HCC, separating them into a study group among those who met the CM and a control group with those who exceeded them (Expanded Group). Taking into account donor and recipient variables, Univariate analysis, and Multivariate Logistic Regression were performed. Graft and overall survival were analyzed using a Kaplan Meyer analysis, a contrast of the survival medians, and Cox regression for both groups. Statistically, the significant value was considered when it was less than 0.05. Results: Of the 100 transplanted patients, 71 (71%) met the CM, with a mean of 1.25 nodules per liver and 27 mm mean dominant nodule size, compared with the Expanded Group, with 29 cases (29%), with a mean of 3.3 nodules and a mean dominant nodule size of 41 mm (p<0.05). In the Multivariate analysis, the sum of the explant nodule size between both study groups was the only statistically significant variable associated with the Expanded group, which had an RR of 1.093 with respect to the Milan group. After a median follow-up of 35.1 months, a 5-year graft survival of 63.2 vs 40.9 months (p=ns) and overall survival of these patients of 64.1 vs 45.3 months (p=ns) was observed between both study groups. The mean age of donors was 69.4 ± 13.8 (22-89), 48 of them (48 percent) were older than 75 years; 19 donors (19 percent) were of the DCD type, and no statistically significant differences were found with respect to the results or the graft survival or overall survival of the patients. At the end of the study, 9 cases of recurrence were detected (9%), 5 of them in patients from the Milan group (7%), and 4 in the Expanded group (14%), without statistical significance. Conclusion: Although no statistically significant differences in overall patient graft survival were observed between patients in the two study groups, a difference in 5-year survival of more than 20% was observed. Patients with HCC beyond the MC, but within the Up to Seven Criteria, presented lower results than the MC group, in terms of survival, but higher results than those offered by other therapies described (TACE, Sorafenib, etc). The age of the donors and DCD (Maastricht III), as an independent factor, have not been influential factors in the early or late results of liver transplantation