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Predictive factors for survival and score application in liver retransplantation for hepatitis C recurrence

World Journal of Gastroenterology 2016年第18期22卷 4547-4558页

作者： Alice Tung Wan Song Rodolphe Sobesky Carmen Vinaixa Jérome Dumortier Sylvie Radenne Francois Durand yvon calmus Géraldine Rousseau Marianne Latournerie Cyrille Feray Valérie Delvart Bruno Roche Stéphanie Haim-Boukobza Anne-Marie Roque-Afonso Denis Castaing Edson Abdala Luiz Augusto Carneiro D’Albuquerque Jean-Charles Duclos-Vallée Marina Berenguer Didier Samuel INSERM Unit 785 Villejuif 94800France Liver and Digestive Organ Transplantation Division Gastroenterology DepartmentUniversity of Sao Paulo Medical SchoolSao Paulo 05403-900Brazil Universite Paris-Sud Villejuif 94800France Liver Transplantation Laboratory LIM-37 Sao Paulo 01246-903Brazil AP-HP Hopital Paul Brousse Villejuif 94800France La Fe Hospital University of Valencia and CiberehdValencia 46026Spain Hopital Edouard Herriot Lyon 69003France Hopital Croix Rousse Lyon 69004France AP-HP Hopital Beaujon Clichy 92110France AP-HP Hopital St Antoine Paris 75011France AP-HP Hopital Salpetriere Paris 75013France CHU Pontchaillou Rennes 35000France AP-HP Hopital Henri Mondor Creteil 94010France Viral Hepatitis Laboratory LIM-47 Sao Paulo 01246-903Brazil

AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus(HCV) recurrence and to apply a survival score to this ***: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers(seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis(FCH) post-first graft presenting with hepatic decompensation. RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease(MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patientswho underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available,

关键词： Antivirals Hepatitis C Mortality Prognosis Retransplantation Risk factors

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Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients

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World Journal of Gastroenterology 2006年第45期12卷 7319-7325页

作者： Thomas Decaens Franoise Roudot-Thoraval Solange Bresson-Hadni Carole Meyer Jean Gugenheim Francois Durand Pierre-Henri Bernard Olivier Boillot Philippe Compagnon yvon calmus Jean Hardwigsen Christian Ducerf Georges Philippe Pageaux Sébastien Dharancy Olivier Chazouillères Daniel Cherqui Christophe Duvoux Service d'Hépatologie et de Gastroentérologie AP-HP Hpital Henri Mondor Créteil Unité INSERM 581 France Département de Santé Publique AP-HP Hpital Henri Mondor Créteil France Service d’Hépatologie Hpital Jean Minjoz Besanon France Service de Transplantation Hpital HautefeuilleStrasbourg France Service de Chirurgie Digestive Hpital L’Ar-chet 2 Nice France Service d’Hépatologie AP-HP Hpital Beau-jon Clichy France Service d’Hépatologie et de Gastroentéro-logie H?pital Pellegrin Bordeaux France Service de Chirurgie Digestive Hpital Edouard Herriot Lyon France Service de Chirurgie Digestive Hpital Ponchaillou Rennes France Service de Chirurgie Digestive AP-HP HpitalCochin Paris France Service de Chirurgie Digestive Hpital laConception Marseille France Service de Chirurgie Digestive Hpital de laCroix Rousse Lyon France Fédération Médico-Chirurgicale deMaladies de l’Appareil Digestif Hpital Saint-Eloi MontpellierFrance Service d’Hépatologie et de Gastroentérologie H?pital Claude Huriez Lille France Service d’Hépatologie AP-HP Hpital SAntoine Paris France Service de Chirurgie Générale et Digestive APHP Hopital Henri Mondor Créteil France

AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free survival after liver transplantation （LT）.METHODS： Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS： Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were： presence of cirrhosis （P = 0.001）, etiology of liver disease （P = 0.03）, α fetoprotein level （〈 200, 200 to 2000, or 〉 2000; P 〈 0.0001）, y-GT activity （N, N to 2N or 〉 2N; P = 0.02）, the number of nodules （1, 2-3 or ≥ 4; P = 0.02）, maximal diameter of the largest nodule （〈 3 cm, 3 to 5 cm or 〉 5 cm; P 〈 0.0001）, the sum of the diameter of the nodules （〈 3 cm, 3 to 5 cm, 5 to 10 cm or 〉10 cm; P 〈 0.0001）, bilobar location （P = 0.01）, preoperative portal thrombosis （P 〈 0.0001）, peri-operative treatment of the tumor （P = 0.002） and chemoembolization （P = 0.03）, tumor differentiation （P = 0.01）, initial type of calcineurin inhibitor （P = 0.003）, the use of antilymphocyte antibodies （P = 0.02）, rejection episodes （P = 0.003） and period of LT （P 〈 0.0001）. By multivariate analysis, 6 variables were independently associated with HCC recurrence： maximal diameter of the largest nodule （P 〈 0.0001）, time of LT （P 〈 0.0001）, tumor differentiation （P 〈 0.0001）, use of anti-lymphocyte antibody （ATG） or anti-CD3 antibody （OKT3）（P = 0.005）, preoperative portal thrombosis （P = 0.06） and the number of nodules （P = 0.06）. CONCLUSION： This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recur

关键词： Immunosuppression Hepatocellular carcinoma Tumor differentiation Liver transplantation

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