Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation

This article discusses the infeasibility of adhering to the Brazil-Milan Criteria for determining whether patients with hepatocellular carcinoma (HCC) should be offered liver transplantation. The Criteria are currently used widely in Brazil. However, since they expand the net of the transplant-eligi...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autor principal:	Alexander Clevewood Ng
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Brazil-Milan Criteria Hepatocellular carcinoma Liver transplantation Milan Criteria Recurrence Systemic therapy Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/4279257e334c4c2695f2c1eff13f0ecf
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4279257e334c4c2695f2c1eff13f0ecf
record_format	dspace
spelling	oai:doaj.org-article:4279257e334c4c2695f2c1eff13f0ecf2021-11-18T04:46:07ZStick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation1665-268110.1016/j.aohep.2021.100537https://doaj.org/article/4279257e334c4c2695f2c1eff13f0ecf2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1665268121002362https://doaj.org/toc/1665-2681This article discusses the infeasibility of adhering to the Brazil-Milan Criteria for determining whether patients with hepatocellular carcinoma (HCC) should be offered liver transplantation. The Criteria are currently used widely in Brazil. However, since they expand the net of the transplant-eligible population, and that transplantation is shown to improve clinical outcomes in HCC patients relative to other treatments, they are inherently attractive and may be adopted by other countries in determining whether HCC patients should receive liver transplantation. I argue that the Criteria unjustifiably disregard the number of tumour nodules found in the patient. This number may be indicative of the recurrence potential of the disease, since these nodules can originate from different clonal populations. The greater the number, the higher the risk these nodules are associated with clones which contain genetic mutations conferring even greater potential for proliferation and dissemination. Clusters of tumour cells may be micro-disseminated to vascular structures surrounding the liver, as well as extrahepatic systems. This increases recurrence potential and reduces the benefit of liver transplantation in these patients. Thus, HCC patients harbouring fewer but larger tumour nodules may present with a more favourable genomic and epigenomic profile than those with more, albeit smaller, tumour nodules. Patients with more tumour nodules may reap greater clinical benefit if initiated on systemic therapy early, rather than wait for a suitable donor liver. Although the Criteria are reached by consensus, with reference to findings from recent studies, as well as scientific theory, it is ripe for review.Alexander Clevewood NgElsevierarticleBrazil-Milan CriteriaHepatocellular carcinomaLiver transplantationMilan CriteriaRecurrenceSystemic therapySpecialties of internal medicineRC581-951ENAnnals of Hepatology, Vol 25, Iss , Pp 100537- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Brazil-Milan Criteria Hepatocellular carcinoma Liver transplantation Milan Criteria Recurrence Systemic therapy Specialties of internal medicine RC581-951
spellingShingle	Brazil-Milan Criteria Hepatocellular carcinoma Liver transplantation Milan Criteria Recurrence Systemic therapy Specialties of internal medicine RC581-951 Alexander Clevewood Ng Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation
description	This article discusses the infeasibility of adhering to the Brazil-Milan Criteria for determining whether patients with hepatocellular carcinoma (HCC) should be offered liver transplantation. The Criteria are currently used widely in Brazil. However, since they expand the net of the transplant-eligible population, and that transplantation is shown to improve clinical outcomes in HCC patients relative to other treatments, they are inherently attractive and may be adopted by other countries in determining whether HCC patients should receive liver transplantation. I argue that the Criteria unjustifiably disregard the number of tumour nodules found in the patient. This number may be indicative of the recurrence potential of the disease, since these nodules can originate from different clonal populations. The greater the number, the higher the risk these nodules are associated with clones which contain genetic mutations conferring even greater potential for proliferation and dissemination. Clusters of tumour cells may be micro-disseminated to vascular structures surrounding the liver, as well as extrahepatic systems. This increases recurrence potential and reduces the benefit of liver transplantation in these patients. Thus, HCC patients harbouring fewer but larger tumour nodules may present with a more favourable genomic and epigenomic profile than those with more, albeit smaller, tumour nodules. Patients with more tumour nodules may reap greater clinical benefit if initiated on systemic therapy early, rather than wait for a suitable donor liver. Although the Criteria are reached by consensus, with reference to findings from recent studies, as well as scientific theory, it is ripe for review.
format	article
author	Alexander Clevewood Ng
author_facet	Alexander Clevewood Ng
author_sort	Alexander Clevewood Ng
title	Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation
title_short	Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation
title_full	Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation
title_fullStr	Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation
title_full_unstemmed	Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation
title_sort	stick to milan: infeasibility of the brazil-milan criteria in recommending patients with hepatocellular carcinoma for liver transplantation
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/4279257e334c4c2695f2c1eff13f0ecf
work_keys_str_mv	AT alexanderclevewoodng sticktomilaninfeasibilityofthebrazilmilancriteriainrecommendingpatientswithhepatocellularcarcinomaforlivertransplantation
_version_	1718425035769643008

Stick to Milan: Infeasibility of the Brazil-Milan Criteria in recommending patients with hepatocellular carcinoma for liver transplantation

Ejemplares similares