Liver transplantation for hepatocellular carcinoma with allografts from donors after circulatory death: Is the tumor recurrence genuinely increased?
Notice bibliographique
Résumé
We thank Mergental et al. for their interesting comments on our article “Inferior Survival in Liver Transplant Recipients With Hepatocellular Carcinoma Receiving Donation After Cardiac Death Liver Allografts.”1 We agree with the authors that there are no hepatocellular carcinoma (HCC) recurrence data in the Scientific Registry of Transplant Recipients database; therefore, it was not possible to demonstrate that this was the cause of inferior survival observed in the HCC–donation after cardiac death (DCD) group. Although we gave early recurrence as a possible explanation for this inferior survival, we also discussed the idea that the use of DCD organs in patients with HCC may be a practice pattern used for patients who are felt to have greater factors for adverse risk. Although we adjusted for all known risk factors available within the Scientific Registry of Transplant Recipients database, we acknowledge that as with all registry databases, there may be some risk factors that are not captured. Mergental et al.'s point that most of the inferior survival in the Kaplan-Meier survival estimates for the HCC-DCD group occurred within the first year is accurate. However, if this inferior survival was related only to inferior graft quality, similarly inferior survival would have been observed for the non-HCC–DCD group, and our interaction term would not have been significant in the multivariate analysis, which we adjusted for the inferiority of DCD allografts. As we stated in the discussion, there was a true potentiation of effect observed in the HCC-DCD group. Mergental et al. comment that “patients undergoing transplantation for HCC have well-preserved liver function and are frequently matched with more marginal grafts.” It should be noted that there was no significant difference in the donor risk indices of the non-HCC–DCD and HCC-DCD groups, and yet the survival was inferior. We also adjusted for DCD graft inferiority in our analysis. In conclusion, our article clearly shows inferior survival for patients with HCC receiving DCD allografts. This is an important finding because the proportion of transplant patients with HCC is ever increasing, and as previous studies have shown, there is a greater tendency to use DCD organs in this population. Our study highlights the importance of trying to further investigate the reason for this inferiority with prospective, multicenter studies looking at recurrence. We agree with Mergental et al. that caution should be taken in assuming that the inferior survival of HCC patients receiving DCD allografts is related to recurrence. Again, we thank Mergental et al. for their comment on our article. Kristopher Croome, M.D., M.S., F.R.C.S.C. Roberto Hernandez-Alejandro, M.D. Western University HPB Surgery and Liver Transplantation London Health Sciences Centre London, Ontario, Canada
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».