The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform
Jean Charles Duclos-vallée - One of the best experts on this subject based on the ideXlab platform.
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Long term survival after liver transplantation of patients with hepatocellular carcinoma due to non-related to HBV, HCV or alcohol cirrhosis
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscription on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible and the outcomes after LT are not well described. Aim. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods. In a monocentric cohort 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 (+10) years (sex ratio M/F = 202/34), Six patients (2.5%) were retransplanted, 13 (5.5%) had normal liver and we studied 217 patients. The main etiologies of liver disease were; HBV cirrhosis (n=49, 22,6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9), undetermined causes (n=4), NASH (n=2), cholestatic and autoimmune disease (n=3). Five and 10 years survival were studied according to MC or presence of vascular invasion from the native liver. Results, Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (B, C or alcohol cirrhosis) {p < 0.01). Five patients were transplanted outside the Milan criteria, four out of "Up to 7" criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60 at 10 years for patients with HCC associated to uncommon hepatopathy and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcohol cirrhosis (p=ns). Conclusions: Patients transplanted for HCC on rare liver disease have similar prognosis to those transplanted for HCC on liver disease related to HCV, HBV or alcohol. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed rare liver disease.
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Prognostic factors of ten years survival after liver transplantation for hepatocellular carcinoma
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, F Blandin, Valerie Delvart, D. Azoulay, R Adam, Ghyslain Pelletier, B Paul, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT). The very long-term survival in patients (pts) transplanted for HCC is poorly studied. Aim. The aim was to study the survival above 10 years after LT for HCC according to Milan criteria (MC) or vascular invasion (VI). Methods. In a monocentric cohort 293 pts were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 years. Six pts were retransplanted, 13 had normal liver and we analyzed 217 pts. The etiologies of liver disease were; HBV (22,6%), HCV (46%), alcohol (23.1%) and others (hemochromatosis, NASH, undetermined causes) (8.3%). After analysis of the native liver, it was concluded that 70 (32.2%) pts were transplanted outside the MC and with VI in 56 (25.8%) cases. Five and 10 years survival were studied according to MC or presence of VI from the native liver. Forty-nine of 87 pts (60.6%) transplanted outside MC or with VI had adjuvant chemotherapy (Cth) with Gemcitabin plus oxaliplatin. Survival in pts transplanted with non-MC or VI who underwent adjuvant Cth has been compared to those who have not had Cth. Results. Overall survival was 71% at 5 years and 60% at 10 years. There was no significant difference in survival according to etiology of cirrhosis. For pts transplanted during 1996 to 2002 (n=96), the survival was 66% and 58% at 5 years and 10 years, respectively. For pts transplanted during 2003 to 2008 (n=121) survival was 69% at 5 years (p=ns). Survival in pts transplanted in the MC (n=147) was 80% at 5 years and 69% at 10 years compared to 54% at 5 years and 44% at 10 years (p
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Survival after liver transplantation for hepatocellular carcinoma for patients with cirrhosis non-related to HBV, HCV or alcoholic cirrhosis
Hepatology, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscriptions on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible. Outcomes after LT for these patients are poorly described. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods: In a monocentric cohort, 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81%) were transplanted. The mean age at LT was 54 (±10) years (sex ratio M/F = 202/34). Six patients (2.5%) were retransplanted, 13 had no underlying liver disease and 217 patients were studied. Main etiologies of liver disease were as follow; HBV cirrhosis (n=49, 22.6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9, 4.1%), cryptogenic cirrhosis (n=4, 1.8%), NASH (n=2, 0.9%), cholestatic and autoimmune disease (n=3, 1.4%). Five and 10 years survival rates were studied after pathological examination of the native liver according to Milan criteria or presence of vascular invasion. Results: Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (HBV, HCV or alcohol cirrhosis) (p < 0.01). Five patients were transplanted outside the Milan criteria, four out of “Up to 7” criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60% at 10 years for patients with HCC associated to uncommon liver disease and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcoholic cirrhosis (p=ns). Conclusions: Patients transplanted for HCC with rare liver disease have similar prognosis to those transplanted for HCC consecutive to HCV, HBV or alcoholic liver disease. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed on rare liver disease. A management of therapy for HCC during the waiting time must be intensified in this subgroup of patients.
R Sobesky - One of the best experts on this subject based on the ideXlab platform.
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Long term survival after liver transplantation of patients with hepatocellular carcinoma due to non-related to HBV, HCV or alcohol cirrhosis
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscription on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible and the outcomes after LT are not well described. Aim. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods. In a monocentric cohort 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 (+10) years (sex ratio M/F = 202/34), Six patients (2.5%) were retransplanted, 13 (5.5%) had normal liver and we studied 217 patients. The main etiologies of liver disease were; HBV cirrhosis (n=49, 22,6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9), undetermined causes (n=4), NASH (n=2), cholestatic and autoimmune disease (n=3). Five and 10 years survival were studied according to MC or presence of vascular invasion from the native liver. Results, Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (B, C or alcohol cirrhosis) {p < 0.01). Five patients were transplanted outside the Milan criteria, four out of "Up to 7" criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60 at 10 years for patients with HCC associated to uncommon hepatopathy and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcohol cirrhosis (p=ns). Conclusions: Patients transplanted for HCC on rare liver disease have similar prognosis to those transplanted for HCC on liver disease related to HCV, HBV or alcohol. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed rare liver disease.
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Prognostic factors of ten years survival after liver transplantation for hepatocellular carcinoma
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, F Blandin, Valerie Delvart, D. Azoulay, R Adam, Ghyslain Pelletier, B Paul, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT). The very long-term survival in patients (pts) transplanted for HCC is poorly studied. Aim. The aim was to study the survival above 10 years after LT for HCC according to Milan criteria (MC) or vascular invasion (VI). Methods. In a monocentric cohort 293 pts were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 years. Six pts were retransplanted, 13 had normal liver and we analyzed 217 pts. The etiologies of liver disease were; HBV (22,6%), HCV (46%), alcohol (23.1%) and others (hemochromatosis, NASH, undetermined causes) (8.3%). After analysis of the native liver, it was concluded that 70 (32.2%) pts were transplanted outside the MC and with VI in 56 (25.8%) cases. Five and 10 years survival were studied according to MC or presence of VI from the native liver. Forty-nine of 87 pts (60.6%) transplanted outside MC or with VI had adjuvant chemotherapy (Cth) with Gemcitabin plus oxaliplatin. Survival in pts transplanted with non-MC or VI who underwent adjuvant Cth has been compared to those who have not had Cth. Results. Overall survival was 71% at 5 years and 60% at 10 years. There was no significant difference in survival according to etiology of cirrhosis. For pts transplanted during 1996 to 2002 (n=96), the survival was 66% and 58% at 5 years and 10 years, respectively. For pts transplanted during 2003 to 2008 (n=121) survival was 69% at 5 years (p=ns). Survival in pts transplanted in the MC (n=147) was 80% at 5 years and 69% at 10 years compared to 54% at 5 years and 44% at 10 years (p
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Survival after liver transplantation for hepatocellular carcinoma for patients with cirrhosis non-related to HBV, HCV or alcoholic cirrhosis
Hepatology, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscriptions on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible. Outcomes after LT for these patients are poorly described. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods: In a monocentric cohort, 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81%) were transplanted. The mean age at LT was 54 (±10) years (sex ratio M/F = 202/34). Six patients (2.5%) were retransplanted, 13 had no underlying liver disease and 217 patients were studied. Main etiologies of liver disease were as follow; HBV cirrhosis (n=49, 22.6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9, 4.1%), cryptogenic cirrhosis (n=4, 1.8%), NASH (n=2, 0.9%), cholestatic and autoimmune disease (n=3, 1.4%). Five and 10 years survival rates were studied after pathological examination of the native liver according to Milan criteria or presence of vascular invasion. Results: Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (HBV, HCV or alcohol cirrhosis) (p < 0.01). Five patients were transplanted outside the Milan criteria, four out of “Up to 7” criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60% at 10 years for patients with HCC associated to uncommon liver disease and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcoholic cirrhosis (p=ns). Conclusions: Patients transplanted for HCC with rare liver disease have similar prognosis to those transplanted for HCC consecutive to HCV, HBV or alcoholic liver disease. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed on rare liver disease. A management of therapy for HCC during the waiting time must be intensified in this subgroup of patients.
Michael Chopp - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance imaging and neurosphere therapy of stroke in rat
Annals of Neurology, 2003Co-Authors: Zheng Gang Zhang, Quan Jiang, Ruilan Zhang, Li Zhang, Lei Wang, Lijei Zhang, Polly Arniego, Khang Loon Ho, Michael ChoppAbstract:We intracisternally transplanted subventricular zone (SVZ) cells labeled by ferromagnetic particles into stroked rats. Migration of transplanted cells was non-invasively tracked using magnetic resonance imaging (MRI). We found that transplanted cells selectively migrated towards the ischemic parenchyma at a mean speed of 65 ± 14.6 μm/hr in living rats. Migration of transplanted cells in the brain was also measured histopathologically. Rats transplanted with SVZ cells exhibited significant improvement of neurological function. Our data suggest that intracisternal transplantation of SVZ cells provides an avenue for cell therapy of stroke and that MRI can be used to track grafted cells in the brain. Ann Neurol 2003
R Adam - One of the best experts on this subject based on the ideXlab platform.
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Long term survival after liver transplantation of patients with hepatocellular carcinoma due to non-related to HBV, HCV or alcohol cirrhosis
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscription on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible and the outcomes after LT are not well described. Aim. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods. In a monocentric cohort 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 (+10) years (sex ratio M/F = 202/34), Six patients (2.5%) were retransplanted, 13 (5.5%) had normal liver and we studied 217 patients. The main etiologies of liver disease were; HBV cirrhosis (n=49, 22,6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9), undetermined causes (n=4), NASH (n=2), cholestatic and autoimmune disease (n=3). Five and 10 years survival were studied according to MC or presence of vascular invasion from the native liver. Results, Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (B, C or alcohol cirrhosis) {p < 0.01). Five patients were transplanted outside the Milan criteria, four out of "Up to 7" criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60 at 10 years for patients with HCC associated to uncommon hepatopathy and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcohol cirrhosis (p=ns). Conclusions: Patients transplanted for HCC on rare liver disease have similar prognosis to those transplanted for HCC on liver disease related to HCV, HBV or alcohol. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed rare liver disease.
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Prognostic factors of ten years survival after liver transplantation for hepatocellular carcinoma
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, F Blandin, Valerie Delvart, D. Azoulay, R Adam, Ghyslain Pelletier, B Paul, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT). The very long-term survival in patients (pts) transplanted for HCC is poorly studied. Aim. The aim was to study the survival above 10 years after LT for HCC according to Milan criteria (MC) or vascular invasion (VI). Methods. In a monocentric cohort 293 pts were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 years. Six pts were retransplanted, 13 had normal liver and we analyzed 217 pts. The etiologies of liver disease were; HBV (22,6%), HCV (46%), alcohol (23.1%) and others (hemochromatosis, NASH, undetermined causes) (8.3%). After analysis of the native liver, it was concluded that 70 (32.2%) pts were transplanted outside the MC and with VI in 56 (25.8%) cases. Five and 10 years survival were studied according to MC or presence of VI from the native liver. Forty-nine of 87 pts (60.6%) transplanted outside MC or with VI had adjuvant chemotherapy (Cth) with Gemcitabin plus oxaliplatin. Survival in pts transplanted with non-MC or VI who underwent adjuvant Cth has been compared to those who have not had Cth. Results. Overall survival was 71% at 5 years and 60% at 10 years. There was no significant difference in survival according to etiology of cirrhosis. For pts transplanted during 1996 to 2002 (n=96), the survival was 66% and 58% at 5 years and 10 years, respectively. For pts transplanted during 2003 to 2008 (n=121) survival was 69% at 5 years (p=ns). Survival in pts transplanted in the MC (n=147) was 80% at 5 years and 69% at 10 years compared to 54% at 5 years and 44% at 10 years (p
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Survival after liver transplantation for hepatocellular carcinoma for patients with cirrhosis non-related to HBV, HCV or alcoholic cirrhosis
Hepatology, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscriptions on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible. Outcomes after LT for these patients are poorly described. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods: In a monocentric cohort, 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81%) were transplanted. The mean age at LT was 54 (±10) years (sex ratio M/F = 202/34). Six patients (2.5%) were retransplanted, 13 had no underlying liver disease and 217 patients were studied. Main etiologies of liver disease were as follow; HBV cirrhosis (n=49, 22.6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9, 4.1%), cryptogenic cirrhosis (n=4, 1.8%), NASH (n=2, 0.9%), cholestatic and autoimmune disease (n=3, 1.4%). Five and 10 years survival rates were studied after pathological examination of the native liver according to Milan criteria or presence of vascular invasion. Results: Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (HBV, HCV or alcohol cirrhosis) (p < 0.01). Five patients were transplanted outside the Milan criteria, four out of “Up to 7” criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60% at 10 years for patients with HCC associated to uncommon liver disease and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcoholic cirrhosis (p=ns). Conclusions: Patients transplanted for HCC with rare liver disease have similar prognosis to those transplanted for HCC consecutive to HCV, HBV or alcoholic liver disease. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed on rare liver disease. A management of therapy for HCC during the waiting time must be intensified in this subgroup of patients.
D. Azoulay - One of the best experts on this subject based on the ideXlab platform.
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Long term survival after liver transplantation of patients with hepatocellular carcinoma due to non-related to HBV, HCV or alcohol cirrhosis
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscription on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible and the outcomes after LT are not well described. Aim. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods. In a monocentric cohort 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 (+10) years (sex ratio M/F = 202/34), Six patients (2.5%) were retransplanted, 13 (5.5%) had normal liver and we studied 217 patients. The main etiologies of liver disease were; HBV cirrhosis (n=49, 22,6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9), undetermined causes (n=4), NASH (n=2), cholestatic and autoimmune disease (n=3). Five and 10 years survival were studied according to MC or presence of vascular invasion from the native liver. Results, Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (B, C or alcohol cirrhosis) {p < 0.01). Five patients were transplanted outside the Milan criteria, four out of "Up to 7" criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60 at 10 years for patients with HCC associated to uncommon hepatopathy and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcohol cirrhosis (p=ns). Conclusions: Patients transplanted for HCC on rare liver disease have similar prognosis to those transplanted for HCC on liver disease related to HCV, HBV or alcohol. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed rare liver disease.
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Prognostic factors of ten years survival after liver transplantation for hepatocellular carcinoma
Liver Transplantation, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, F Blandin, Valerie Delvart, D. Azoulay, R Adam, Ghyslain Pelletier, B Paul, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Background. Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT). The very long-term survival in patients (pts) transplanted for HCC is poorly studied. Aim. The aim was to study the survival above 10 years after LT for HCC according to Milan criteria (MC) or vascular invasion (VI). Methods. In a monocentric cohort 293 pts were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81 %) were transplanted. The mean age at LT was 54 years. Six pts were retransplanted, 13 had normal liver and we analyzed 217 pts. The etiologies of liver disease were; HBV (22,6%), HCV (46%), alcohol (23.1%) and others (hemochromatosis, NASH, undetermined causes) (8.3%). After analysis of the native liver, it was concluded that 70 (32.2%) pts were transplanted outside the MC and with VI in 56 (25.8%) cases. Five and 10 years survival were studied according to MC or presence of VI from the native liver. Forty-nine of 87 pts (60.6%) transplanted outside MC or with VI had adjuvant chemotherapy (Cth) with Gemcitabin plus oxaliplatin. Survival in pts transplanted with non-MC or VI who underwent adjuvant Cth has been compared to those who have not had Cth. Results. Overall survival was 71% at 5 years and 60% at 10 years. There was no significant difference in survival according to etiology of cirrhosis. For pts transplanted during 1996 to 2002 (n=96), the survival was 66% and 58% at 5 years and 10 years, respectively. For pts transplanted during 2003 to 2008 (n=121) survival was 69% at 5 years (p=ns). Survival in pts transplanted in the MC (n=147) was 80% at 5 years and 69% at 10 years compared to 54% at 5 years and 44% at 10 years (p
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Survival after liver transplantation for hepatocellular carcinoma for patients with cirrhosis non-related to HBV, HCV or alcoholic cirrhosis
Hepatology, 2011Co-Authors: R Sobesky, Christophe Guettier, M. Sebagh, D X Castaing, D. Azoulay, R Adam, Ghyslain Pelletier, David Samuel, Faouzi Saliba, Jean Charles Duclos-valléeAbstract:Hepatocellular carcinoma (HCC) is a leading cause of liver transplantation (LT) and currently represents about 30% of inscriptions on the waiting list. Most causes of liver diseases responsible for HCC are related to HCV, HBV or alcohol. However, other causes of liver disease inducing HCC are possible. Outcomes after LT for these patients are poorly described. The aim of this work was to study the long-term prognosis of patients transplanted for HCC related to uncommon etiologies of cirrhosis. Methods: In a monocentric cohort, 293 patients were enrolled on the transplant list for HCC between 1996 and 2008 and 236 (81%) were transplanted. The mean age at LT was 54 (±10) years (sex ratio M/F = 202/34). Six patients (2.5%) were retransplanted, 13 had no underlying liver disease and 217 patients were studied. Main etiologies of liver disease were as follow; HBV cirrhosis (n=49, 22.6%), HCV cirrhosis (n=100, 46%), alcoholic cirrhosis (n=50, 23.1%). Uncommon etiologies of cirrhosis responsible for HCC were hemochromatosis (n=9, 4.1%), cryptogenic cirrhosis (n=4, 1.8%), NASH (n=2, 0.9%), cholestatic and autoimmune disease (n=3, 1.4%). Five and 10 years survival rates were studied after pathological examination of the native liver according to Milan criteria or presence of vascular invasion. Results: Eighteen of 28 patients (64%) enrolled on the transplant list for HCC with uncommon cause of cirrhosis were transplanted vs 82% in other groups (HBV, HCV or alcohol cirrhosis) (p < 0.01). Five patients were transplanted outside the Milan criteria, four out of “Up to 7” criteria and 2 with vascular invasion. Survival was 66% at 5 years and 60% at 10 years for patients with HCC associated to uncommon liver disease and 71% at 5 years and 60 % at 10 years for patients with HCC related to HBV, HCV or alcoholic cirrhosis (p=ns). Conclusions: Patients transplanted for HCC with rare liver disease have similar prognosis to those transplanted for HCC consecutive to HCV, HBV or alcoholic liver disease. However, the rate of drop out is higher among patients awaiting transplantation for HCC developed on rare liver disease. A management of therapy for HCC during the waiting time must be intensified in this subgroup of patients.
