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The Role of Tumor Ablation in Bridging Patients to Liver Transplantation
E. William Johnson, MD, MPH;
Peter S. Holck, PhD;
Adam E. Levy, MD;
Matthew M. Yeh, MD, PhD;
Raymond S. Yeung, MD
Arch Surg. 2004;139:825-830.
Hypothesis Treatment of hepatocellular carcinoma before liver transplantation can curb local tumor progression and thereby prolong patients' transplantation eligibility.
Design Retrospective case-control pilot study. Twelve of 39 patients receiving liver transplantation for hepatocellular carcinoma had treatment before transplantation. Pretreatment included radiofrequency ablation (n = 8), percutaneous ethanol injection (n = 2), both modalities (n = 1), and tumor resection (n = 1). Twelve control subjects without pretreatment who were age-, sex-, and score-matched on the Model for End-stage Liver Disease and Child-Turcotte-Pugh classification were selected. The primary outcome measure was the waiting period for transplantation.
Results Patients with pretreatment waited on the transplant list significantly longer than their counterparts without pretreatment (median, 484 vs 253 days; P = .03).
Conclusions Treatment before transplantation with tumor ablation or resection is associated with a longer waiting period on the transplant list. This enables patients who might otherwise be removed from the list because of tumor progression to receive transplantation.
From the Departments of Surgery (Drs Johnson, Levy, and Yeung) and Pathology (Dr Yeh), University of Washington School of Medicine, Seattle; and Department of Public Health Sciences and Epidemiology, University of Hawaii John A. Burns School of Medicine, Honolulu (Dr Holck).
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