Liver transplantation for hepatocellular carcinoma with allografts from donors after circulatory death: Is the tumor recurrence genuinely increased?
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".