Transplant Oncology for Primary and Secondary Liver Tumors: A Patient-level Metaanalysis Compared to Standard and Non-standard Indications for Liver Transplantation

Document Type

Conference Proceeding

Publication Date

7-1-2023

Publication Title

HPB

Abstract

Background: Concerns about the safety of Transplant Oncology have been raised. However, some other controversial indications (such as re-transplants, combined organs or high-risk recipients), are been currently performed with no questioning. The main aim of our research is to put all the indications of liver transplantation (LT) for malignancies in the context of standard and controversial wide-accepted indications considering overall reported outcomes. Methods: PubMed, Embase and WoS were screened selecting studies that included transplanted patients for intrahepatic and hilar cholangiocarcinoma (iCC-hCC), metastatic neuroendocrine tumors (NET) and liver metastases from colorectal cancer (CRLM). Pooled and patient-level survival data meta-analyses were performed and comparative analyses were made with OS outcomes of patients transplanted for standard (n = 66924), standard+HCC (n=19804) and unusual but accepted (n = 53754) indications collected from the UNOS database between 2005 and 2020 (PROSPERO CRD4202022268510). Results: An initial set of 1205, 1951, 3302 and 2461 manuscripts were identified from which 23, 17, 16 and 11 manuscripts including 484, 796, 751 and 103 patients were finally analyzed from series in which LT has been performed for iCC, hCC, NET, CRLNM, respectively. Secondary patient-level survival data meta-analyses were performed including 345, 721, 494 and 103 patients, respectively. By merging survival data obtained from UNOS database and the 4 meta-analyses, TrOncol indications have lower survival than Standard Indications. However, when compared with “non-standard” indications, 5-year overall survival was significantly better than 4thredo-transplant, combined liver and pancreas and similar to 3 redo transplant and LT on recipients >70yo. Five-year OS rates for Transplant Oncology indications were above 50% except for pCC which was 47.4%. Conclusions: Outcomes of Transplant Oncology indications are beyond the minimal requirement of 50% 5y OS and higher than other indications performed during routine practice. Liver transplant teams and National Organizations should ensure protocols to incorporate Transplant Oncology indications within routine LT indications under strict selection criteria.

Volume

25

First Page

S233

Last Page

S234

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