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. 2017 Feb;24(2):526-534.
doi: 10.1245/s10434-016-5500-0. Epub 2016 Aug 16.

The Warsaw Proposal for the Use of Extended Selection Criteria in Liver Transplantation for Hepatocellular Cancer

Michał Grąt  1 , Karolina M Wronka  2 , Jan Stypułkowski  2 , Emil Bik  2 , Maciej Krasnodębski  2 , Łukasz Masior  2 , Zbigniew Lewandowski  3 , Karolina Grąt  4 , Waldemar Patkowski  2 , Marek Krawczyk  2
Affiliations

The Warsaw Proposal for the Use of Extended Selection Criteria in Liver Transplantation for Hepatocellular Cancer

Michał Grąt et al. Ann Surg Oncol. 2017 Feb.

Abstract

Background: Combination of the University of California, San Francisco (UCSF) and the up-to-7 criteria with alpha-fetoprotein (AFP) cutoff of 100 ng/ml was proposed as the Warsaw expansion of the Milan criteria in selection of hepatocellular cancer (HCC) patients for liver transplantation. The purpose of this retrospective study was to validate this proposal.

Methods: A total of 240 HCC patients after liver transplantation were included. Recurrence-free survival and overall survival at 5 years were set as the primary and secondary outcome measures, respectively.

Results: The Warsaw expansion increased transplant eligibility rate by 20.3 %. AFP >100 ng/ml significantly increased the recurrence risk in patients within the Milan criteria (p = 0.025) and in those beyond, yet within either the UCSF or the up-to-7 criteria (p < 0.001). Recurrence-free survival at 5 years was 90.8 % for patients within the Milan criteria, 100.0 % in patients within the Warsaw expansion, 54.9 % in patients beyond the Warsaw expansion but within either the UCSF or the up-to-7 criteria, and 45.1 % in patients beyond both the UCSF and the up-to-7 criteria (p < 0.001). The corresponding overall survival rates were 71.6, 82.4, 64.3, and 55.3 %, respectively (p = 0.027).

Conclusions: The Warsaw expansion of the Milan criteria substantially increases the recipient pool without compromising outcomes.

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Figures

Fig. 1
Fig. 1
Recurrence-free survival and overall survival curves in patients within (solid lines) and beyond (dashed lines) the Milan criteria (a, b) and in patients within the Milan criteria (solid lines), beyond the Milan but within either the UCSF or the up-to-7 criteria (dashed lines), and beyond (dotted lines) both the UCSF and the up-to-7 criteria (c, d). Numbers of patients at risk are presented below the particular graphs
Fig. 2
Fig. 2
Recurrence-free survival and overall survival curves in patients within the Milan criteria (solid lines), beyond the Milan criteria but within the Warsaw expansion (short-dashed lines), beyond the Milan criteria and Warsaw expansion but within either the UCSF or the up-to-7 criteria (dotted lines), and beyond both the UCSF and the up-to-7 criteria (long-dashed lines) (a, b) and in patients within (solid lines) and beyond (dashed lines) the Warsaw criteria (c, d). Numbers of patients at risk are presented below the particular graphs
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