TY - JOUR
T1 - Liver transplantation for hepatocellular carcinoma
T2 - A survey of practices
AU - Kleek, Erik J.Van
AU - Schwartz, Jonathan M.
AU - Rayhill, Stephen C.
AU - Rosen, Hugo R.
AU - Cotler, Scott J.
PY - 2006/8
Y1 - 2006/8
N2 - GOAL: To survey physician practices regarding liver transplantation for patients with hepatocellular carcinoma (HCC). BACKGROUND: Many issues surrounding liver transplantation for HCC are controversial and physician practices have not been well characterized. METHODS: Transplant physicians and surgeons were electronically surveyed regarding surveillance, diagnosis, selection criteria for deceased and living donor transplantation, and use of adjunctive therapy for HCC. RESULTS: Eighty-nine of 174 (51%) physicians completed the survey (39 hepatologists, 41 transplant surgeons, and 9 others). Most respondents were from large US transplant centers. All reported screening for HCC during transplant evaluation, and 98% surveyed patients awaiting transplant. Sixty percent of respondents would biopsy lesions under selective conditions, whereas 32% never biopsy lesions, and 8% biopsy all lesions. Eighty two percent of respondents claimed to adhere to the Milan criteria (single lesion ≤5 cm or no more than 3 lesions each ≤3 cm without vascular invasion) for patient selection, however, 36% would transplant patients with tumors that invade a small portal branch. Forty one percent of respondents would consider living donor transplantation for patients with tumors exceeding the Milan criteria. Ninety-six percent of respondents treat HCC before transplantation, and 87% would transplant patients down-staged to meet the Milan criteria. CONCLUSIONS: There is consistency related to HCC surveillance and treatment in liver transplant candidates. Variations of responses regarding biopsy of lesions, patient selection for deceased donor and living donor transplantation highlight a need for evidence-based guidelines.
AB - GOAL: To survey physician practices regarding liver transplantation for patients with hepatocellular carcinoma (HCC). BACKGROUND: Many issues surrounding liver transplantation for HCC are controversial and physician practices have not been well characterized. METHODS: Transplant physicians and surgeons were electronically surveyed regarding surveillance, diagnosis, selection criteria for deceased and living donor transplantation, and use of adjunctive therapy for HCC. RESULTS: Eighty-nine of 174 (51%) physicians completed the survey (39 hepatologists, 41 transplant surgeons, and 9 others). Most respondents were from large US transplant centers. All reported screening for HCC during transplant evaluation, and 98% surveyed patients awaiting transplant. Sixty percent of respondents would biopsy lesions under selective conditions, whereas 32% never biopsy lesions, and 8% biopsy all lesions. Eighty two percent of respondents claimed to adhere to the Milan criteria (single lesion ≤5 cm or no more than 3 lesions each ≤3 cm without vascular invasion) for patient selection, however, 36% would transplant patients with tumors that invade a small portal branch. Forty one percent of respondents would consider living donor transplantation for patients with tumors exceeding the Milan criteria. Ninety-six percent of respondents treat HCC before transplantation, and 87% would transplant patients down-staged to meet the Milan criteria. CONCLUSIONS: There is consistency related to HCC surveillance and treatment in liver transplant candidates. Variations of responses regarding biopsy of lesions, patient selection for deceased donor and living donor transplantation highlight a need for evidence-based guidelines.
KW - Hepatocellular carcinoma
KW - Liver transplantation
KW - Survey of practices
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U2 - 10.1097/00004836-200608000-00018
DO - 10.1097/00004836-200608000-00018
M3 - Article
C2 - 16917411
AN - SCOPUS:33747458925
SN - 0192-0790
VL - 40
SP - 643
EP - 647
JO - Journal of clinical gastroenterology
JF - Journal of clinical gastroenterology
IS - 7
ER -