T. De Feo

The Long-Term Benefit of Liver Transplantation for Hepatic Metastases From Neuroendocrine Tumors

Selection criteria and benefit of liver transplantation for hepatic metastases from neuroendocrine tumors (NETs) remain uncertain. Eighty‐eight consecutive patients with metastatic NETs eligible for liver transplantation according to Milan‐NET criteria were offered transplant (n = 42) versus nontransplant options (n = 46) depending on list dynamics, patient disposition, and age. Tumor burden between groups did not differ. Transplant patients were younger (40.5 vs. 55.5 years; p < 0.001). Long‐term outcomes were compared after matching between groups made on multiple Cox models adjusted for propensity score built on logistic models. Survival benefit was the difference in mean survival between transplant versus nontransplant options. No patients were lost or died without recurrence. Median follow‐up was 122 months. The transplant group showed a significant advantage over nontransplant strategies at 5 and 10 years in survival (97.2% and 88.8% vs. 50.9% and 22.4%, respectively; p < 0.001) and time‐to‐progression (13.1% and 13.1% vs. 83.5% and 89%; p < 0.001). After adjustment for propensity score, survival advantage of the transplant group was significant (hazard ratio = 7.4; 95% confidence interval (CI): 2.4–23.0; p = 0.001). Adjusted transplant‐related survival benefit was 6.82 months (95% CI: 1.10–12.54; p = 0.019) and 38.43 months (95% CI: 21.41–55.45; p < 0.001) at 5 and 10 years, respectively. Liver transplantation for metastatic NETs under restrictive criteria provides excellent long‐term outcome. Transplant‐related survival benefit increases over time and maximizes after 10 years.

A prospective policy development to increase split-liver transplantation for 2 adult recipients: Results of a 12-year multicenter collaborative study

Objective:To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients. Background:Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated. Methods:We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome. Results:Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%) Conclusions:AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.

Full‐Right‐Full‐Left Split Liver Transplantation: The Retrospective Analysis of an Early Multicenter Experience Including Graft Sharing

Full‐right‐full‐left split liver transplantation divides a donor liver into two grafts to be transplanted in adult‐size patients. Major technical and organizational difficulties have limited its application to few single center series. We retrospectively analyzed the long‐term results of the first multicenter series of this procedure with graft sharing. Between November 1998 and January 2005, 43 transplants were performed by five centers from 23 full‐right‐full‐left in situ split liver procedures; 65% of the grafts were shared. A total of 31 (72%) patients had complications above grade II; 3 (6.9%) were retransplanted. Hospital mortality was 23% with sepsis as the main cause. Six patients died in the long term, two of them for a road accident. A total of 27 patients are alive after a median follow‐up of 3200 days (2035–4256). Actuarial survival at 1 and 10 years were 72.1%, 62.6% and 65.1%, 57.9%, respectively for patients and grafts. These figures are similar to those reported for adult living donor liver transplantation by the European Registry over a similar period. Multicenter collaboration in sharing of these grafts is feasible and can help facing the organizational limits, thus increasing diffusion of full‐right‐full‐left split liver transplantation.

Circulating burst-forming-unit erythroid and the responsiveness to recombinant human erythropoietin in patients on regular hemodialytic treatment

The dose of recombinant human erythropoietin (r-HuEpo) required to correct anemia of end-stage renal disease varies among patients. The possible factors that interfere with the responsiveness to r-HuEpo were not completely known. In 32 patients on regular hemodialytic treatment with marked anemia (Hb 5.6 +/- 0.7 g/dl), we evaluated circulating erythroid progenitor cells [burst-forming-unit erythroid (BFU-E)], erythropoietin, ferritin, folate and 1-84-parathormone levels before r-HuEpo therapy. In 12 patients, the aluminum levels after deferoxamine were also evaluated. The possible correlation between these factors and the response to r-HuEpo therapy was then evaluated. The number of circulating (c) BFU-E was highly variable (521 +/- 447 colonies/ml of blood; normal level 742 +/- 192) and does not correlate with erythropoietin, ferritin, folate, 1-84-parathormone or aluminum levels. A direct correlation between basal cBFU-E and the responsiveness to r-HuEpo therapy was recorded while no correlation was found with the other analyzed parameters. We hypothesized that low basal cBFU-E (interleukin-3 deficiency?) could reduce the response to r-HUEpo because of failure of this hematopoietic stem cell compartment to replenish the pool of more mature erythropoietic progenitor cells during the phase of accelerated maturation induced by r-HuEpo.

810 INTERPLAY BETWEEN ON-TREATMENT PREDICTORS AND DONOR/RECIPIENT (D/R) IL28B STATUS IN PREDICTING SUSTAINED VIROLOGICAL RESPONSE (SVR) IN HCV-1,4 LIVER TRANSPLANT (LT) RECIPIENTS TREATED WITH PEG-INTERFERON+ RIBAVIRIN (PR)

810 INTERPLAY BETWEEN ON-TREATMENT PREDICTORS AND DONOR/RECIPIENT (D/R) IL28B STATUS IN PREDICTING SUSTAINED VIROLOGICAL RESPONSE (SVR) IN HCV-1,4 LIVER TRANSPLANT (LT) RECIPIENTS TREATED WITH PEG-INTERFERON+RIBAVIRIN (PR) M.F. Donato, C. Rigamonti, A.J. Bastiampillai, A. Aghemo, E. Galmozzi, T. De Feo, E. Longhi, G. Rossi, M. Colombo. 1st Division of Gastroenterology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, North Italy Transplant Program, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Liver Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Universita degli Studi di Milano, Milan, Italy E-mail: francesca.donato@policlinico.mi.it

108 A NOVEL MODEL OF PRIORITY ASSESSMENT FOR PATIENTS WITH AND WITHOUT HEPATOCELLULAR CARCINOMA ON A COMMON LIVER TRANSPLANT WAITING LIST: A MULTICENTRE, COHORT STUDY

108 A NOVEL MODEL OF PRIORITY ASSESSMENT FOR PATIENTS WITH AND WITHOUT HEPATOCELLULAR CARCINOMA ON A COMMON LIVER TRANSPLANT WAITING LIST: A MULTICENTRE, COHORT STUDY A. Vitale, T.M. De Feo, P. Burra, A.C. Frigo, R. Ramirez Morales, L. De Carlis, M. Manini, S. Fagiuoli, A. Picciotto, P. Toniutto, E. Regalia, U. Cillo, on behalf of the Liver Transplantation NITp Working Group. University Hospital of Padova, Padova, North Italy Transplant Program, Fond. IRCCS Ca’ Granda OMP, Milan, Biostatistics Unit, University of Padova, Padova, Liver Transplantation, Ospedale Niguarda Ca’ Granda, Gastroenterology Unit, Maggiore Hospital Policlinico, Milan, Gastroenterology and Transplantation Hepatology, Ospedali Riuniti, Bergamo, IRCCS San Martino, IST, Genova, Medical Liver Transplant Unit, University of Udine, Udine, Liver Transplantation, IRCCS INT, Milan, Italy E-mail: alessandro.vitale@unipd.it