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Listing HCC Patients for OLT: Mayo Rochester

Listing HCC Patients for OLT: Mayo Rochester. “Milan Criteria” 1 lesion  5 cm 3 lesions  3 cm no vascular invasion no extrahepatic disease. CP1078132-42. Radiographic Criteria for the Diagnosis of HCC. Cirrhosis  2 cm mass identified by 2 imaging modalities

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Listing HCC Patients for OLT: Mayo Rochester

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  1. Listing HCC Patients for OLT: Mayo Rochester • “Milan Criteria” • 1 lesion  5 cm • 3 lesions  3 cm • no vascular invasion • no extrahepatic disease This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  2. CP1078132-42

  3. Radiographic Criteria for theDiagnosis of HCC • Cirrhosis •  2 cm mass identified by 2 imaging modalities • Arterial contrast enhancement on CT, MRI, angiography or • AFP >100 ng/mL CP1078132-7 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  4. Radiographic Criteria for theDiagnosis of HCC • Accuracy 99.6% • Sensitivity 100% • Specificity 98.9% • Positive predictive value 99.3% • Negative predictive value 100% Torzilli et al: Hepatology 30:889, 1999 CP1078132-8 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  5. Staging Patients with HCC for OLT Initial Staging: •Triple Liver Imaging - Ultrasound - CT Scan (abd and chest) - Angiography - Bone Scan • Re-staged: every 3 months - CT scan (chest and abd) This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  6. Staging Patients with HCC for OLT • Size • largest size on any imaging study • Number of Lesions • greatest number of lesions on any imaging study This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  7. Chemoembolization Hepatocellularcarcinoma Hepaticartery • Ivalon plus • CDDP • Adriamycin • Mitomycin C Catheter CP1078132-34 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  8. Tumor Progression Following Chemoebmolization for HCC Control Treated Probability(%) Months Hepatology 27:1578, 1998 CP1078132-40

  9. Survival Curves of the Chemoembolization and Control Groups Chemoembolization n=40 Probability of survival (%) Control n=35 Log-rank P<0.009 Time since randomization (months) Lancet 18:1734, 2002 CP1078048-1 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  10. Outcome of Patients with HCC Listed for OLT 54 46 OLT 8 removed from the list This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  11. Medical Indications for delisting patients with HCC 8 6 progression 1 death (subdural hematoma) of HCC 1 M.I. This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  12. UNOS classification for HCC • Stage I, T1 1.9 cm • Stage II, T2 1 lesion 2-5 cm 3 lesions all 3 cm • Stage III, T3 1 lesion >5 cm 2-3 lesions, 1> 3 cm This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  13. UNOS Stage OLT Progression or Death T1 6 1 T2 36 5 T3 4 2 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  14. Waiting Time Until OLT • Median time 211 days (range 28-1099 days) This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  15. Kaplan-Meier Estimate of Tumor Progression or Death on the Waiting List 95% CI Cumulativeincidence 28.8% 14.7% 95% CI 6.9% Month CP1093694-1 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  16. Drop Out on the Waiting List Dueto HCC Progression Survival (%) Months Patients (no.) 46 35 20 11 5 Liver Transplantation 8:873, 2002 CP1086015-1 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  17. 6 Month MELD Equivalent Score • 19.5 (14.4 - 24.3) This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  18. Recommendations This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  19. Consensus Criteria for Diagnosis of HCC • Lesion >2 cm • two coincident imaging studies • contrast enhancement • Lesion <2 cm • pathology via biopsy This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

  20. MELD Score Equivalent for HCC • T2 lesions: Meld of 20 • if not transplanted in 4-6 months, 24 This presentation is reproduced on this site with the permission of the author(s). All opinions, research citations and analyses are those of the author(s) and may not reflect those of OPTN/UNOS committees or the OPTN/UNOS Board of Directors.

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