AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. ...AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.展开更多
The selection of patients with colorectal cancer liver metastases(CRLM)for liver transplantation(LT)represents a significant challenge,requiring a balance between oncological outcomes and organ scarcity.Recent advance...The selection of patients with colorectal cancer liver metastases(CRLM)for liver transplantation(LT)represents a significant challenge,requiring a balance between oncological outcomes and organ scarcity.Recent advancements in transplantation outcomes for CRLM have prompted the establishment of rigorous selection criteria to optimize patient survival and graft utilization.This review examines the key criteria used to select candidates for LT in this setting,with a focus on oncological factors,patient characteristics,and response to therapy.Eligible candidates are typically those with non-resectable liver-only CRLM,demonstrating controlled primary tumor disease.Tumor biology is a critical determinant,excluding patients exhibiting high-risk molecular features such as BRAF or RAS mutations.Furthermore,candidates must show a favorable response to systemic chemotherapy,with either tumor stability or reduction in size and no extrahepatic progression during a defined treatment period.Specific tumor burden scores,such as the Oslo score or criteria based on the number and size of lesions,aid in stratifying candidates with acceptable recurrence risks.Other factors,including age,performance status,and absence of significant comorbidities,are also pivotal.Long-term follow-up data highlight the importance of stringent patient selection,showing superior 5-year survival in patients meeting these criteria compared to those who do not.In conclusion,strict selection criteria based on tumor biology,systemic disease control,and patient-specific factors ensure optimized outcomes for LT in CRLM patients,marking a pivotal step toward broader clinical acceptance of this novel approach.展开更多
文摘AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.
文摘The selection of patients with colorectal cancer liver metastases(CRLM)for liver transplantation(LT)represents a significant challenge,requiring a balance between oncological outcomes and organ scarcity.Recent advancements in transplantation outcomes for CRLM have prompted the establishment of rigorous selection criteria to optimize patient survival and graft utilization.This review examines the key criteria used to select candidates for LT in this setting,with a focus on oncological factors,patient characteristics,and response to therapy.Eligible candidates are typically those with non-resectable liver-only CRLM,demonstrating controlled primary tumor disease.Tumor biology is a critical determinant,excluding patients exhibiting high-risk molecular features such as BRAF or RAS mutations.Furthermore,candidates must show a favorable response to systemic chemotherapy,with either tumor stability or reduction in size and no extrahepatic progression during a defined treatment period.Specific tumor burden scores,such as the Oslo score or criteria based on the number and size of lesions,aid in stratifying candidates with acceptable recurrence risks.Other factors,including age,performance status,and absence of significant comorbidities,are also pivotal.Long-term follow-up data highlight the importance of stringent patient selection,showing superior 5-year survival in patients meeting these criteria compared to those who do not.In conclusion,strict selection criteria based on tumor biology,systemic disease control,and patient-specific factors ensure optimized outcomes for LT in CRLM patients,marking a pivotal step toward broader clinical acceptance of this novel approach.
