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CC BY-NC-ND 4.0 · Z Gastroenterol 2024; 62(01): 43-49
DOI: 10.1055/a-2228-7496
Originalarbeit

Liver transplantation for HCC in cirrhosis: Are Milan criteria outdated?

Lebertransplantation bei HCC: Sind Milan-Kriterien überholt?
Jan-Paul Gundlach 
1   Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
,
Mark Ellrichmann 
2   Interdisciplinary Endoscopy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Marieke van Rosmalen
3   Eurotransplantat International Foundation, Leiden, Netherlands
,
Serge Vogelaar
3   Eurotransplantat International Foundation, Leiden, Netherlands
,
Christine Eimer
4   Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
,
Corinna Rheinbay
1   Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
,
Sabina Rösgen
1   Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
,
Jost-Philipp Schäfer
5   Clinic for Radiology und Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Thomas Becker
1   Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
,
Michael Linecker‡
1   Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
,
Felix Braun‡
1   Department of General, Visceral-, Thoracic-, Transplant- and Pediatric-Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
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Abstract

In Germany, organ allocation is based on the MELD-system and lab-MELD is usually low in patients with hepatocellular carcinoma (HCC) in cirrhosis. Higher medical urgency can be achieved by standard exception for HCC (SE-HCC), if Milan criteria (MC) are met. Noteworthy, UNOS T2 reflects MC, but excludes singular lesions < 2 cm. Thus, SE-HCC is awarded to patients with one lesion between 2 and 5 cm or 2 to 3 lesions between 1 and 3 cm. These criteria are static and do not reflect biological properties of HCC.

We present a retrospective cohort of 111 patients, who underwent liver transplantation at UKSH, Campus Kiel between 2007 and 2017. No difference was found in overall survival for patient cohorts using Milan, UCSF, up-to-seven, and French-AFP criteria. However, there was a significantly reduced survival, if microvascular invasion was detected in the explanted organ and in patients with HCC-recurrence. The exclusive use of static selection criteria including MC appear to limit the access to liver transplantation.

Zusammenfassung

Die Organallokation zur Lebertransplantation in Deutschland basiert auf dem MELD-System. Patienten mit einem hepatozellulären Karzinom (HCC) in Zirrhose weisen meist einen niedrigen laborchemischen (lab-)MELD auf. Eine Priorisierung der Dringlichkeit auf der Warteliste kann durch eine Standard-Exception (SE-HCC) erfolgen, wenn die Milan-Kriterien (MC) erfüllt sind. Die Richtlinie verwendet UNOS T2, welche MC entsprechen aber singuläre Tumoren unter 2 cm ausschließen. Die Priorisierung erfolgt nach rein statischen Kriterien und berücksichtigt keine weiteren biologischen Tumoreigenschaften.

In einer retrospektiven Studie analysierten wir 111 Patienten, die zwischen 2007 und 2017 am UKSH, Campus Kiel, transplantiert wurden. Das Gesamt-Überleben der Patienten unterteilt nach Milan-, UCSF-, up-to-seven- sowie French-AFP-Kriterien zeigte keine signifikanten Unterschiede. Demgegenüber fand sich bei mikrovaskulärer Invasion im Explantat sowie in der Rezidiv-Situation ein signifikant schlechteres Gesamtüberleben.

Die ausschließliche Verwendung statischer Selektionskriterien einschließlich MC impliziert einen eingeschränkten Zugang zur Lebertransplantation.

Keywords

Liver transplantation - hepatocellular carcinoma - allocation - selection criteria - Milan criteria

Schlüsselwörter

Lebertransplantation - hepatozelluläres Karzinom - Allokation - Selektionskriterien - Milan Kriterien


Publication History

Received: 08 September 2023

Accepted after revision: 03 December 2023

Article published online:
09 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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